Glen Avenue Family Practice

LBN: Syed Masood Ali, Mdsc
Glen Avenue Family Practice is an health care organization with primary practice located at 4930 N Executive Dr , Peoria IL 61614-4894. The organization recently has only one registered license in Allopathic & Osteopathic Physicians / General Practice, which is considered as the primary health care specialty. Syed Masood Ali, Mdsc can be contacted via phone (309) 692-7575, or through Lafollette, Susan via phone (309) 671-8749.

Contact Information

Primary practice address
4930 N Executive Dr Peoria IL 61614-4894
Phone: (309) 692-7575
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Lafollette, Susan
Phone: (309) 671-8749

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / General Practice 208D00000X 036067626 Illinois

Profile Details

NPI number 1689896961
LBN Legal business name Syed Masood Ali, Mdsc
DBA Doing business as Glen Avenue Family Practice
Authorized official Lafollette, Susan
Entity Organization
Organization subpart 1 No
Enumeration date May 3rd, 2007
Last updated Jun 30th, 2008 - about 18 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 1689896961 NPPES
Illinois Other 212719 MEDICARE GROUP ID

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