Organization
DAVID G VERMILLION M D P C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY M. SMITH (BILLER/CODER)
(815) 942-5200
Entity
Organization
Contact information
Practice address
1802 N DIVISION ST STE 201, MORRIS, IL 60450-1183
(815) 513-5625
(815) 513-5624
Mailing address
1802 N DIVISION ST STE 201, MORRIS, IL 60450-1183
(815) 513-5625
(815) 513-5624
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
207R00000X
IL
208000000X
Pediatrics Physician
208000000X
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0003221864
BLUE CROSS BLUE SHIELD
IL
01
—
019038
HEALTH ALLIANCE
IL
05
—
036082906
—
IL
01
—
370009963
RAIL ROAD MEDICARE
IL
Enumeration date
06/08/2006
Last updated
12/18/2017
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