Peoria Integrative Medical Center Ltd

LBN: Peoria Integrative Medical Center Ltd
Peoria Integrative Medical Center Ltd is an health care organization with primary practice located at 4930 N Executive Dr Suite B, Peoria IL 61614-4894. The organization recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as the primary health care specialty. Peoria Integrative Medical Center Ltd can be contacted via phone (309) 683-6002, or through Xie, Yang via phone (309) 636-7302.

Contact Information

Primary practice address
4930 N Executive Dr Suite B Peoria IL 61614-4894
Phone: (309) 683-6002
Fax: (309) 683-6007
Website:
Map and Directions
Authorized official contact:
Name: Xie, Yang Doctor of Medicine (MD)
Phone: (309) 636-7302

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 036114042 Illinois

Profile Details

NPI number 1699839985
LBN Legal business name Peoria Integrative Medical Center Ltd
DBA Doing business as
Authorized official Xie, Yang Doctor of Medicine (MD)
Entity Organization
Organization subpart 1 No
Enumeration date Dec 20th, 2006
Last updated Apr 20th, 2009 - about 17 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 1699839985 NPPES
Illinois MEDICAID 036114042

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