| Victoria J Brockhouse, DO | |
|
702 W Chestnut St, Bloomington, IL 61701-2814 | |
| (309) 567-1400 | |
| (309) 557-1461 |
| Full Name | Victoria J Brockhouse |
|---|---|
| Gender | Female |
| Speciality | Family Medicine |
| Location | 702 W Chestnut St, Bloomington, Illinois |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790744555 | NPI | - | NPPES |
| 036081580 | Other | STATE LIC | |
| 833120 | Other | IL | MEDICARE GROUP |
| 036081580 | Medicaid | IL | |
| 080040113 | Other | IL | RR MEDICARE GROUP PTAN |
| CA2264 | Other | RR MEDICARE GROUP PTAN | |
| 336043935 | Other | CONT SUBS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 336.043935 (Illinois) | Primary |
| 207Q00000X | Family Medicine | 036081580 (Illinois) | Secondary |
| Entity Name | Chestnut Health Systems, Inc. |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1366431686 PECOS PAC ID: 1052393063 Enrollment ID: O20040603000738 |
| Mailing Address | Practice Location Address |
|---|---|
| Victoria J Brockhouse, DO 2540 College And University, Normal, IL 61790-2540 Ph: (309) 438-2956 | Victoria J Brockhouse, DO 702 W Chestnut St, Bloomington, IL 61701-2814 Ph: (309) 567-1400 |
Dr. Justin James Holschbach, M.D. Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 308 Saint Joseph Dr, Bloomington, IL 61701 Phone: 309-663-5050 Fax: 309-662-3401 | |
Thomas L Murphy, D.O. Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 1111 Trinity Ln Ste 111, Bloomington, IL 61704 Phone: 309-661-6414 Fax: 309-661-4666 | |
Jermy Enrique Crespo Gonzalez, MD Family Medicine Medicare: Not Enrolled in Medicare Practice Location: 2200 East Washington Street, Bloomington, IL 61701 Phone: 309-665-5996 | |
Stephen Belgrave, M.D. Family Medicine Medicare: Not Enrolled in Medicare Practice Location: 1701 E College Ave, Bloomington, IL 61704 Phone: 309-664-3170 | |
Mfowethu Theophilus Langeni, DO Family Medicine Medicare: Medicare Enrolled Practice Location: 210 Saint Joseph Dr, Bloomington, IL 61701 Phone: 309-663-5050 Fax: 309-662-3401 | |
Bernadette Ray, MD Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 2103 E Washington St Ste 1d, Bloomington, IL 61701 Phone: 888-240-1121 Fax: 888-240-1121 | |
Shilpa Mehta, Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 1505 Eastland Dr, Bloomington, IL 61701 Phone: 309-663-2100 Fax: 309-663-8322 |