Organization
ILLINOIS VALLEY SPINE INSTITUTE LLC
Active
Organization
ILLINOIS VALLEY SPINE INSTITUTE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JASON BERGANDI M.D. (ORTHOPAEDIC SURGEON)
(815) 780-8627
Entity
Organization
Contact information
Practice address
4231 PROGRESS BLVD, 4, PERU, IL 61354-1193
(815) 780-8627
(815) 780-8630
Mailing address
4231 PROGRESS BLVD, 4, PERU, IL 61354-1193
(815) 780-8627
(815) 780-8630
Taxonomy
Speciality
Code
Description
License number
State
207XS0117X
Orthopaedic Surgery of the Spine Physician
Primary
036-114114
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036-114114
—
IL
01
—
IL6014
MEDICARE
IL
Enumeration date
08/11/2011
Last updated
11/28/2011
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