Organization
CARDIAC THORACIC & ENDOVASCULAR THERAPIES, S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAMES BERTRAM WILLIAMS MD (OWNER/PRESIDENT)
(309) 680-8666
Entity
Organization
Contact information
Practice address
2420 W NEBRASKA AVE, PEORIA, IL 61604-3112
(309) 680-5000
(309) 680-1002
Mailing address
2420 W NEBRASKA AVE, PEORIA, IL 61604-3112
(309) 680-5000
(309) 680-1002
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
—
IL
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036099138
—
IL
01
—
7232062
BLUE SHIELD PROVIDER NO
IL
01
—
DS6728
RETIRED RAILROAD MEDICARE
IL
01
—
P00059260
RETIRED RAILROAD MEDICARE
IL
Enumeration date
07/31/2006
Last updated
01/30/2015
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