Organization
DANVILLE POLYCLINIC, LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MELISSA A EDINGTON (ADMINISTRATOR)
(217) 477-4750
Entity
Organization
Contact information
Practice address
707 N LOGAN AVE, DANVILLE, IL 61832-4360
(217) 446-6410
(217) 477-4757
Mailing address
707 N LOGAN AVE, DANVILLE, IL 61832-4360
(217) 446-6410
(217) 477-4757
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
060000812
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
09215807
BCBS OF ILLINOIS
IL
05
—
100002020A
—
IN
01
—
1486765
UMWA
—
01
—
221069
BLACK LUNG
—
Enumeration date
06/12/2006
Last updated
11/25/2008
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