1982170734 NPI number — OSF MULTI-SPECIALTY GROUP

Table of content: (NPI 1982170734)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982170734 NPI number — OSF MULTI-SPECIALTY GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OSF MULTI-SPECIALTY GROUP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
OSF ONCALL URGENT CARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982170734
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
124 SW ADAMS ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PEORIA
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61602-1308
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
309-655-2850
Provider Business Mailing Address Fax Number:
309-655-4878

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10408 N CENTERWAY DR STE CDE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PEORIA
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61615-1234
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
309-308-5100
Provider Business Practice Location Address Fax Number:
309-308-5101
Provider Enumeration Date:
10/19/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SEHRING
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
C
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
309-655-2850

Provider Taxonomy Codes

  • Taxonomy code: 332900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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