1942411491 NPI number — SHER INSTITUTE FOR REPRODUCTIVE MEDICINE CENTRAL ILLINOIS PC

Table of content: (NPI 1942411491)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942411491 NPI number — SHER INSTITUTE FOR REPRODUCTIVE MEDICINE CENTRAL ILLINOIS PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHER INSTITUTE FOR REPRODUCTIVE MEDICINE CENTRAL ILLINOIS PC
Provider Last Name:
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Provider Middle Name:
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Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
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NPI Number Information

NPI Number:
1942411491
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/23/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5320 S RAINBOW BLVD
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89118
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-794-0073
Provider Business Mailing Address Fax Number:
702-696-0554

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5401 N KNOXVILLE AVE
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
PEORIA
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61614-5098
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
309-389-0411
Provider Business Practice Location Address Fax Number:
309-689-0784
Provider Enumeration Date:
05/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MCNICHOL
Authorized Official First Name:
MILTON
Authorized Official Middle Name:
Authorized Official Title or Position:
DOCTOR
Authorized Official Telephone Number:
309-389-0411

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  25MA05747100 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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