Organization
SODERSTROM DERMATOLOGY CENTER S C
Active
Parent organization
SODERSTROM DERMATOLOGY CENTER S C
Other names
Peoria Ambulatory Surgery Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
SODERSTROM DERMATOLOGY CENTER S C
Authorized official
TINA M PEUGH MBA (EXECUTIVE DIRECTOR, SODERSTROM DERM)
(309) 674-7546
Entity
Organization
Contact information
Practice address
4909 N GLEN PARK PLACE RD, PEORIA, IL 61614-4676
(309) 690-6012
Mailing address
4909 N GLEN PARK PLACE RD, PEORIA, IL 61614-4676
(309) 690-6012
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
7001530
IL
Other
Enumeration date
05/12/2006
Last updated
06/25/2008
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