Organization
DECATUR DIGESTIVE DISEASE CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VICTOR ELOY MD (MEDICAL DIRECTOR)
(217) 233-0003
Entity
Organization
Contact information
Practice address
2 MEMORIAL DR SUITE 102, PHYSICIAN PLAZA WEST, DECATUR, IL 62526-3950
(217) 233-0003
(217) 233-0077
Mailing address
2 MEMORIAL DR SUITE 102, PHYSICIAN PLAZA WEST, DECATUR, IL 62526-3950
(217) 233-0003
(217) 233-0077
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
7002983
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
50402
BLUE CROSS BLUE SHIELD
IL
01
—
P00257307
MEDICARE RAILROAD
IL
Enumeration date
04/25/2006
Last updated
04/01/2013
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