Organization
BROMENN HEALTHCARE HOSPITALS
Active
Other names
BroMenn Family Health Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KATHY O. DAVIS (VP & CHIEF INFORMATION OFFICER)
(309) 268-2410
Entity
Organization
Contact information
Practice address
1300 FRANKLIN AVE, SUITE 100, NORMAL, IL 61761-3588
(309) 268-3761
(309) 268-5620
Mailing address
1300 FRANKLIN AVE, SUITE 100, NORMAL, IL 61761-3588
(309) 268-3761
(309) 268-5620
Taxonomy
Speciality
Code
Description
License number
State
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5715390
BLUE CROSS BLUE SHIELD
IL
Enumeration date
06/18/2006
Last updated
10/06/2008
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