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Organization

DECATUR DIGESTIVE DISEASE CENTER LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
VICTOR ELOY MD (MEDICAL DIRECTOR)
(217) 875-2640
Entity
Organization

Contact information

Practice address
2 MEMORIAL DR, SUITE 102 PYSICIAN 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
367500000X
Certified Registered Nurse Anesthetist
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
P00257307
MEDICARE RAILROAD
IL
Enumeration date
04/25/2006
Last updated
04/20/2008
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