Organization
EAGLE FAMILY MEDICINE SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT SCOTT BEVILL MD (PHYSICIAN PRESIDENT)
(309) 692-6604
Entity
Organization
Contact information
Practice address
2809 W WILLOW KNOLLS SUITE C, PEORIA, IL 61614-8259
(309) 692-6604
(309) 692-6492
Mailing address
2809 W WILLOW KNOLLS SUITE C, PEORIA, IL 61614-8259
(309) 692-6604
(309) 692-6492
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
208745
MEDICARE GROUP NUMBER
IL
01
—
K37812
MEDICARE PROVIDER NUMBER
IL
Enumeration date
03/02/2007
Last updated
07/10/2008
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