Organization
DANVILLE POLYCLINIC, LTD
Active
Other names
DANVILLE POLYCLINIC LTD ASTC
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MELISSA A EDINGTON (ADMINISTRATOR)
(217) 477-4794
Entity
Organization
Contact information
Practice address
707 N LOGAN AVE, DANVILLE, IL 61832-4360
(217) 477-4794
(217) 477-4757
Mailing address
707 N LOGAN AVE, DANVILLE, IL 61832-4360
(217) 477-4794
(217) 477-4757
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
7002371
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1525
BCBS OF ILLINOIS
IL
01
—
167654
PERSONAL CARE/COVENTRY
—
05
—
200315840A
—
IN
Enumeration date
06/12/2006
Last updated
09/30/2008
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