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Organization
COMPREHENSIVE BLEEDING DISORDERS CENTER
Active
Organization
COMPREHENSIVE BLEEDING DISORDERS CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARY L DAVIS (EXECUTIVE DIRECTOR)
(309) 688-1345
Entity
Organization
Contact information
Practice address
4727 N SHERIDAN RD, PEORIA, IL 61614-5925
(309) 688-1345
(309) 688-0917
Mailing address
4727 N SHERIDAN RD, PEORIA, IL 61614-5925
(309) 688-1345
(309) 688-0917
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
054014575
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
21623343
BCBS OF IL
IL
Enumeration date
09/23/2005
Last updated
08/08/2008
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