Basic Information
Provider Information | |||||||||
NPI: | 1629791025 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | OSF MULTI-SPECIALTY GROUP | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | OSF ONCALL URGENT CARE | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 2779 VOLUNTEER DR STE 201 | ||||||||
Address2: |   | ||||||||
City: | GALESBURG | ||||||||
State: | IL | ||||||||
PostalCode: | 614018618 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3096552850 | ||||||||
FaxNumber: | 3096554878 | ||||||||
Practice Location | |||||||||
Address1: | 2779 VOLUNTEER DR STE 201 | ||||||||
Address2: |   | ||||||||
City: | GALESBURG | ||||||||
State: | IL | ||||||||
PostalCode: | 614018618 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3096552850 | ||||||||
FaxNumber: | 3096554878 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/21/2022 | ||||||||
LastUpdateDate: | 11/01/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | KRANTZ | ||||||||
AuthorizedOfficialFirstName: | AMY | ||||||||
AuthorizedOfficialMiddleName: | M. | ||||||||
AuthorizedOfficialTitleorPosition: | MANAGER, STRATEGIC REIMBURSEMENT | ||||||||
AuthorizedOfficialTelephone: | 3096552865 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | Y | ||||||||
ParentOrganizationLBN: | OSF HEALTHCARE SYSTEM | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 11/01/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332900000X |   |   | Y |   | Suppliers | Non-Pharmacy Dispensing Site |   |
No ID Information.