Organization
PEORIA PULMONARY ASSOCIATES, LTD.
Active
Other names
Illinois Lung Institute
Organization subpart
No
Provider details
NPI number
Authorized official
JANET L JACKSON (EMR MANAGER)
(309) 672-5682
Entity
Organization
Contact information
Practice address
1001 MAIN ST, SUITE 200, PEORIA, IL 61606-1907
(309) 672-5682
(309) 672-3147
Mailing address
1001 MAIN ST, SUITE 200, PEORIA, IL 61606-1907
(309) 672-5682
(309) 672-3147
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
—
—
207RP1001X
Pulmonary Disease Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7215056
BCBS GROUP NUMBER
IL
Enumeration date
05/19/2006
Last updated
01/21/2009
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