| NPI | 1760113104 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PATRICK CAPLIS CEO 309-886-9172 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 174400000X Specialist |
| 207Q00000X Family Medicine | |
| 207R00000X Internal Medicine | |
| 261QP2000X Clinic/Center, Physical Therapy | |
| 261QR0200X Clinic/Center, Radiology | |
| 291U00000X Clinical Medical Laboratory | |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| Enumeration Date | 2022-06-17 |
| Last Update Date | 2024-05-08 |