Organization
PRAIRIE SPINE & PAIN INSTITUTE OF SOUTHERN ILLINOIS, LLC
Active
Parent organization
PRAIRIE SPINE & PAIN INSTITUTE
Organization subpart
Yes
Provider details
NPI number
Legal business name
PRAIRIE SPINE & PAIN INSTITUTE
Authorized official
DR. RICHARD A KUBE II MD (PRESIDENT)
(309) 691-7774
Entity
Organization
Contact information
Practice address
1306 N RUSSELL ST, MARION, IL 62959-4570
(309) 691-7774
(309) 689-5768
Mailing address
PO BOX 5173, PEORIA, IL 61601-5173
(309) 691-7774
(309) 689-5768
Taxonomy
Speciality
Code
Description
License number
State
207XS0117X
Orthopaedic Surgery of the Spine Physician
Primary
036112907
IL
Other
Enumeration date
05/17/2011
Last updated
01/23/2015
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