Organization
ILLINOIS REGIONAL PAIN INSTITUTE, S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. GAYLE MUCCIANTE (PRACTICE ADMINISTRATOR)
(309) 692-7246
Entity
Organization
Contact information
Practice address
5401 N KNOXVILLE AVE, SUITE #416, PEORIA, IL 61614-5098
(309) 692-7246
(309) 692-7226
Mailing address
5401 N KNOXVILLE AVE, SUITE #416, PEORIA, IL 61614-5098
(309) 692-7246
(309) 692-7226
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
036114669
IL
Other
Enumeration date
06/25/2006
Last updated
01/03/2014
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