Organization
CENTRAL ILLINOIS PREVENTIVE SERVICES LLC
Active
Parent organization
CENTRAL ILLINOIS PREVENTIVE SERVICES LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
CENTRAL ILLINOIS PREVENTIVE SERVICES LLC
Authorized official
LARRY OVERCASH MD (OWNER)
(309) 696-9010
Entity
Organization
Contact information
Practice address
1603 TULLAMORE AVE STE A, BLOOMINGTON, IL 61704-9623
(309) 808-6407
Mailing address
1603 TULLAMORE AVE STE A, BLOOMINGTON, IL 61704-9623
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
08/17/2023
Last updated
08/17/2023
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