Organization
PEKIN PROHEALTH INC
Active
Other names
PHI X-Ray
Organization subpart
No
Provider details
NPI number
Authorized official
SHARON ADAMS (VICE PRESIDENT)
(309) 353-0787
Entity
Organization
Contact information
Practice address
19 OLT AVE, PEKIN, IL 61554-6216
(309) 353-0902
(309) 347-2623
Mailing address
600 S 13TH ST, PEKIN, IL 61554-4936
(309) 353-0902
(309) 347-2623
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
009180787
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009180787
—
IL
01
—
09015685
BCBS
IL
Enumeration date
10/24/2008
Last updated
12/30/2008
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