| NPI | 1205807187 |
|---|---|
| Doing Business As | MEDICAL SERVICE PLAN AT PEORIA |
| Entity Type | Organization |
| Authorized Contact | WILLIAM R NICHOLAS Executive Director Msp 312-413-0573 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2080P0203X Pediatrics, Pediatric Critical Care Medicine |
| Enumeration Date | 2006-01-30 |
| Last Update Date | 2020-08-22 |