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PROVENA MEDICAL GROUP
NPI 1255526687
Pediatrics in Danville, IL

Active since September 10, 2007
102 N LOGAN AVE, DANVILLE, IL 61832(217) 442-5863(217) 442-5040 Get Directions Write a Review

NPPES record last updated: April 20, 2008. Verified against the NPPES registry weekly; last sync: August 30, 2026.

About Provena Medical Group NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PROVENA MEDICAL GROUP (NPI 1255526687) is a healthcare organization registered as a pediatrics in Danville, Illinois and active in the NPI registry since September 2007. The organization lists Daniel Boland, Financial Reporting Manager, as its authorized official.

NPPES Registry Identity

NPI1255526687
Entity TypeOrganization
Primary Taxonomy208000000X
Legal Business NamePROVENA SERVICE CORPORATION
Location Address102 N LOGAN AVEDanville, IL 61832-8513
Mailing Address9223 W Saint Francis RdFrankfort, IL 60423-8330 · (815) 806-3111
Phone(217) 442-5863
Fax(217) 442-5040
Organization SubpartYes
Authorized OfficialDaniel BolandFinancial Reporting Manager · (815) 806-3111
Enumeration DateSeptember 10, 2007
Last NPPES UpdateApril 20, 2008
✔ NPI 1255526687 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatricsAllopathic & Osteopathic Physicians
Taxonomy Code208000000X
Definition
A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.
102 N LOGAN AVE, Danville, IL 61832
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Other Names 1

Doing Business AsProvena Medical Group

Other Identifiers 2

Medicaid=========003IL
Medicare PIN148931

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X MULTIPLE SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES 4

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. SABEEHA HAQUE ALI MD
Pediatrics
102 N LOGAN AVE
DANVILLE, IL 61832
Vermilion County (217) 442-5863
BHIROM BURANAKUL MD LLC
Clinic/Center (Rural Health)
102 N LOGAN AVE
DANVILLE, IL 61832
Vermilion County (217) 442-5863
SYDNEY LEEANNE SCHAUS CPNP-PC
Nurse Practitioner (Pediatrics)
102 N LOGAN AVE
DANVILLE, IL 61832
Vermilion County (217) 442-5863
SABEEHA HAQUE ALI MD LLC
Clinic/Center (Rural Health)
102 N LOGAN AVE
DANVILLE, IL 61832
Vermilion County (217) 442-5863

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Provena Service Corporation's NPI number?

The NPI number for Provena Service Corporation is 1255526687. It was assigned to this organization in the NPPES registry on September 10, 2007. The provider is doing business as Provena Medical Group.

Where is Provena Service Corporation located?

Provena Service Corporation is located at 102 N Logan Ave, Danville, IL 61832. The listed phone number is (217) 442-5863.

What is Provena Service Corporation's specialty?

The primary specialty registered for this NPI is Pediatrics with taxonomy code 208000000X.

When was this NPI record last updated?

The NPPES record for Provena Service Corporation was last updated on April 20, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.