GREATER PEORIA OBSTETRICS & GYNECOLOGY CORP SC NPI 1912129271

NPI Information

GREATER PEORIA OBSTETRICS & GYNECOLOGY CORP SC is a specialist in Peoria, IL. The provider is an individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. GREATER PEORIA OBSTETRICS & GYNECOLOGY CORP SC NPI is 1912129271. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

4930 N EXECUTIVE DR
PEORIA, IL
ZIP 61614-894
Phone: (309) 671-8749
Fax: (309) 671-8749

The provider's authorized official is Judy Mueller .
The authorized official title is Manager and has the following contact phone number (309) 692-7575.

The CLIA number assigned to this NPI record is 14D2094931 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 5/3/2007 and was last updated on 5/1/2015.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

Other Identifiers

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