Organization · Type 2 NPI

Provena Service Corporation

Family Medicine Physician · Danville, IL

NPI number 1134314602 Active

Practice location

405 Sheridan St
Danville, IL 61832-4451

Call (217) 431-6330 Map

Mailing address

9223 W Saint Francis Rd
Frankfort, IL 60423-8330

Specialties and licenses

Taxonomy	Code	License
Family Medicine Physician Primary	207Q00000X	None listed

Family Medicine Physician: Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

2 other providers at this address

Other family medicine physician providers in Danville

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NPI record

NPI: 1134314602
Entity type: Organization (Type 2)
Issued: Sep 7, 2007
Last updated: Apr 20, 2008
Status: Active
Subpart: Yes of Provena Service Corporation

Other names

<unavail>
Provena Medical Group · doing business as

Authorized official

Mr. Daniel Boland
Financial Reporting Specialist
(815) 806-3111

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This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1134314602

Provena Service Corporation's National Provider Identifier is 1134314602, issued on Sep 7, 2007. The primary taxonomy on file is Family Medicine Physician (207Q00000X), and the practice location is in Danville, IL. The record was last updated on Apr 20, 2008.