Organization
CENTRAL ILLINOIS PULMONARY & CRITICAL CARE ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BERNARD G TAYLOR MD (PRESIDENT)
(309) 645-8588
Entity
Organization
Contact information
Practice address
600 E 1ST ST, SPRING VALLEY, IL 61362-1512
(309) 645-8588
(309) 579-3011
Mailing address
132 E MOSSVILLE RD, PEORIA, IL 61615-9793
(309) 645-8588
(309) 579-3011
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
—
—
207RS0012X
Sleep Medicine (Internal Medicine) Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036053087
—
IL
01
—
212629
MEDICARE ID
IL
Enumeration date
02/08/2006
Last updated
03/11/2019
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