PEORIA INTEGRATIVE MEDICAL CENTER LTD NPI 1699839985

Family Medicine in Peoria, IL

About PEORIA INTEGRATIVE MEDICAL CENTER LTD

Peoria Integrative Medical Center Ltd is a provider in Peoria, IL. The NPI number assigned to this provider is 1699839985. The practitioner's primary taxonomy code is Family Medicine (207Q00000X). The provider is registered as an organization and their NPI record was last updated 9 years ago. Peoria Integrative Medical Center Ltd operates as a single speciality business group with one or more individual providers who practice the same area of specialization.

NPI1699839985 Additional informationCallout TooltipNational Provider Indentifier (NPI)
The 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.
Provider NamePEORIA INTEGRATIVE MEDICAL CENTER LTD
Provider Location Address4930 N EXECUTIVE DR SUITE B PEORIA, IL 61614 Additional informationCallout TooltipProvider location address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Mailing Address4930 N EXECUTIVE DR SUITE B PEORIA, IL 61614 Additional informationCallout TooltipProvider mailing address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.
NPI Entity TypeOrganization Additional informationCallout TooltipEntity type code
The code describing the type of health care provider that is being assigned an NPI.
Codes are:
1 = (Person): individual human being who furnishes health care;
2 = (Non-person): entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO).
Is Sole Proprietor?N/A
Is Organization Subpart?No Additional informationCallout TooltipWhat is a subpart?
Subparts are the components and separate physical locations of organization health care providers. Examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.
Enumeration Date12-20-2006 Additional informationCallout TooltipProvider enumeration date
The date the provider was assigned a unique identifier (assigned an NPI)
Last Update Date04-20-2009 Additional informationCallout TooltipLast update date
The date that a record was last updated or changed.

Business Address

PEORIA INTEGRATIVE MEDICAL CENTER LTD
4930 N EXECUTIVE DR
SUITE B
PEORIA, IL
ZIP 61614
Phone: (309) 683-6002
Fax: (309) 683-6007
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Mailing Address

PEORIA INTEGRATIVE MEDICAL CENTER LTD
4930 N EXECUTIVE DR
SUITE B
PEORIA, IL
ZIP 61614
Phone: (309) 683-6002
Fax: (309) 683-6007

Primary Taxonomy

Taxonomy Code207Q00000X Additional informationCallout TooltipPrimary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
ClassificationFamily Medicine
TypeAllopathic & Osteopathic Physicians
License No.036114042
License StateIL
Taxonomy DescriptionFamily Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

Authorized Official

Authorized Official Name YANG XIE M.D. Additional informationCallout TooltipAuthorized official name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.
Authorized Official TitleOWNER
Authorized Official Phone(309) 636-7302

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

Additional Identifiers


Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State
I44462MEDICARE UPIN (02)IL
214777MEDICARE PIN (08)IL
036114042MEDICAID (05)IL

Map Location


PEORIA INTEGRATIVE MEDICAL CENTER LTD address is 4930 N EXECUTIVE DR SUITE B PEORIA, IL 61614

Other Providers at the same location


The following 4 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1689896961SYED MASOOD ALI, MDSC
Organization
General Practice4930 N EXECUTIVE DR
PEORIA, IL 61614
(309) 692-7575
1700805439DR. SYED MASOOD ALI M.D.
Individual
Family Medicine4930 N EXECUTIVE DR
PEORIA, IL 61614
(309) 691-3707
1801874565 MAQBOOL B ALI M.D
Individual
Surgery4930 N EXECUTIVE DR
PEORIA, IL 61614
(309) 692-7575
1912129271GREATER PEORIA OBSTETRICS & GYNECOLOGY CORP SC
Organization
Specialist4930 N EXECUTIVE DR
PEORIA, IL 61614
(309) 671-8749