| Central Illinois Preventive Services LLC | |
|
1603 Tullamore Ave Ste A Bloomington IL 61704-9623 | |
| (309) 808-6407 | |
| Not Available |
| Full Name | Central Illinois Preventive Services LLC |
|---|---|
| Speciality | Family Medicine |
| Location | 1603 Tullamore Ave Ste A, Bloomington, Illinois |
| Authorized Official Name and Position | Larry Overcash (OWNER) |
| Authorized Official Contact | 3096969010 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Central Illinois Preventive Services LLC 1603 Tullamore Ave Ste A Bloomington IL 61704-9623 | Central Illinois Preventive Services LLC 1603 Tullamore Ave Ste A Bloomington IL 61704-9623 Ph: (309) 808-6407 |
| NPI Number | 1144003633 |
|---|---|
| Provider Enumeration Date | 08/17/2023 |
| Last Update Date | 08/17/2023 |
| Certification Date | 08/17/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144003633 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | () | Primary |
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