| Davis Family Health Llc | |
|
1212 Currency Ct Ste A Rochelle IL 61068-2321 | |
| (815) 561-8500 | |
| (815) 561-8501 |
| Full Name | Davis Family Health Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1212 Currency Ct Ste A, Rochelle, Illinois |
| Authorized Official Name and Position | Kelly Ann Tonielli Davis (OWNER) |
| Authorized Official Contact | 8155618500 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Davis Family Health Llc 1212 Currency Ct Ste A Rochelle IL 61068-2321 Ph: (815) 561-8500 | Davis Family Health Llc 1212 Currency Ct Ste A Rochelle IL 61068-2321 Ph: (815) 561-8500 |
| NPI Number | 1518435247 |
|---|---|
| Provider Enumeration Date | 11/12/2018 |
| Last Update Date | 11/12/2018 |
| Medicare PECOS PAC ID | 8628407764 |
|---|---|
| Medicare Enrollment ID | O20200410001547 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518435247 | NPI | - | NPPES |
| 1225553803 | Other | IL | NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Kelly Ann Davis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225553803 PECOS PAC ID: 3577839802 Enrollment ID: I20180501001987 |
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