Organization
SPRINGFIELD NEUROSURGICAL ASSOCAITES, S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TERRENCE L PENCEK M.D., PH.D. (CEO)
(217) 793-9600
Entity
Organization
Contact information
Practice address
2921 MONTVALE DR, SPRINGFIELD, IL 62704-5359
(217) 793-9600
(217) 793-8975
Mailing address
2921 MONTVALE DR, SPRINGFIELD, IL 62704-5359
(217) 793-9600
(217) 793-8975
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
036078656
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036078656
—
IL
01
—
140003749
RR MEDICARE
IL
01
—
8420196
BCBS OF IL
IL
Enumeration date
01/28/2008
Last updated
10/11/2010
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