Organization
STREATOR CHIDLRENS CLINIC
Active
Other names
Streator Children's Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KEADY GILLMAN (OFFICE MANAGER)
(815) 673-2353
Entity
Organization
Contact information
Practice address
111 SPRING ST FL 5, STREATOR, IL 61364-3332
(815) 673-2353
(815) 673-2486
Mailing address
111 SPRING ST FL 5, STREATOR, IL 61364-3332
(815) 673-2353
(815) 673-2486
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
036091951
IL
261QP2300X
Primary Care Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036091951
—
IL
Enumeration date
12/09/2015
Last updated
06/29/2022
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