Organization
PEORIA OBSTETRICS & GYNECOLOGY, S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. PAULA M CLARK (PRACTICE ADMINISTRATOR)
(309) 687-4242
Entity
Organization
Contact information
Practice address
900 MAIN ST STE 660, PEORIA, IL 61602-1060
(309) 687-4230
(309) 272-7704
Mailing address
900 MAIN ST STE 660, PEORIA, IL 61602-1060
(309) 687-4230
(309) 272-7704
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
036084069
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036044919
—
IL
05
—
036062138
—
IL
05
—
036065639
—
IL
05
—
036084069
—
IL
05
—
036098292
—
IL
05
—
036108543
—
IL
05
—
036111906
—
IL
Enumeration date
03/28/2007
Last updated
01/26/2009
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