Organization
CENTRAL ILLINOIS NERVE TESTING LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN D RUFF DPM (DR)
(309) 691-1727
Entity
Organization
Contact information
Practice address
3322 W WILLOW KNOLLS RD, PEORIA, IL 61614-8148
(309) 691-1727
(309) 637-2325
Mailing address
614 SPRING ST, PEORIA, IL 61603-4133
(309) 637-3668
(309) 637-2325
Taxonomy
Speciality
Code
Description
License number
State
213EP1101X
Primary Podiatric Medicine Podiatrist
Primary
016003701
IL
302F00000X
Exclusive Provider Organization
016003701
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1083613293
ANTHONY V DECEANNE DPM
IL
01
—
1093885378
MARK SMITH, DPM
IL
01
—
1114926748
CURTIS WARD, DPM
IL
01
—
1285613463
T. KEVIN BRATTAIN, DPM
IL
Enumeration date
06/02/2008
Last updated
09/19/2008
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