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Organization

PREMIER MEDICAL GROUP, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. PHIL ARTHUR MCGOWAN (ADMINISTRATOR)
(309) 451-1123
Entity
Organization

Contact information

Practice address
1401 EASTLAND DR STE B, BLOOMINGTON, IL 61701-3553
(309) 451-1123
(309) 451-1212
Mailing address
1401 EASTLAND DR STE B, BLOOMINGTON, IL 61701-3553
(309) 451-1123
(309) 451-1212

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
207V00000X
Obstetrics & Gynecology Physician
207X00000X
Orthopaedic Surgery Physician
208200000X
Plastic Surgery Physician
208600000X
Surgery Physician
Primary
208800000X
Urology Physician
367500000X
Certified Registered Nurse Anesthetist

Other

Enumeration date
11/08/2010
Last updated
12/08/2023
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