Illinois Valley Podiatry

LBN: Illinois Valley Podiatry Group Pc
Illinois Valley Podiatry is an health care organization with primary practice located at 3322 W Willow Knolls , Peoria IL 61614. The organization recently has 4 registered licenses in different health care specialties including Podiatric Medicine & Surgery Service Providers / Podiatrist, Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery, Podiatric Medicine & Surgery Service Providers / Foot Surgery, Suppliers / Durable Medical Equipment & Medical Supplies. Podiatric Medicine & Surgery Service Providers / Podiatrist is the primary health care specialty. Illinois Valley Podiatry Group Pc can be contacted via phone (309) 691-5800, or through Brattain, Thomas Kevin via phone (309) 691-5800.

Contact Information

Primary practice address
3322 W Willow Knolls Peoria IL 61614
Phone: (309) 691-5800
Fax: (309) 691-1336
Website:
Map and Directions
Authorized official contact:
Name: Brattain, Thomas Kevin Doctor of Podiatric Medicine (DPM)
Phone: (309) 691-5800

Health care specialties

SpecialtyCodeLicense #State
Podiatric Medicine & Surgery Service Providers / Podiatrist 213E00000X
Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery 213ES0103X
Podiatric Medicine & Surgery Service Providers / Foot Surgery 213ES0131X
Suppliers / Durable Medical Equipment & Medical Supplies 332B00000X Illinois

Profile Details

NPI number 1750506846
LBN Legal business name Illinois Valley Podiatry Group Pc
DBA Doing business as Illinois Valley Podiatry
Authorized official Brattain, Thomas Kevin Doctor of Podiatric Medicine (DPM)
Entity Organization
Organization subpart 1 No
Enumeration date Apr 16th, 2007
Last updated Feb 21st, 2013 - about 13 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1750506846 NPPES
Illinois Other 0007215174 BLUE CROSS BLUE SHIELD
Illinois Other CM5560 BLUE CROSS BLUE SHIELD

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