Basic Information
| Provider Information | |||||||||
| NPI: | 1326485921 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ILLINOIS NEUROSCIENCE INSTITUTE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 800 NE GLEN OAK AVE | ||||||||
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| City: | PEORIA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 616033255 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3096552850 | ||||||||
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| Practice Location | |||||||||
| Address1: | 100 NE RANDOLPH AVE | ||||||||
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| City: | PEORIA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 616061919 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8774646670 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2013 | ||||||||
| LastUpdateDate: | 05/23/2013 | ||||||||
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| AuthorizedOfficialLastName: | SCHOEPLEIN | ||||||||
| AuthorizedOfficialFirstName: | KEVIN | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 3096552850 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | OSF HEALTHCARE SYSTEM | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Neurological Surgery |
No ID Information.