Provider Demographics
NPI:1104510650
Name:VSR PLLC
Entity type:Organization
Organization Name:VSR PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VENU
Authorized Official - Middle Name:M
Authorized Official - Last Name:RANGU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:715-387-9055
Mailing Address - Street 1:4200 CONESTOGA DR STE 102
Mailing Address - Street 2:PO BOX 178
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62711-7937
Mailing Address - Country:US
Mailing Address - Phone:715-207-1134
Mailing Address - Fax:
Practice Address - Street 1:180 W IMBODEN DR
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62521-5238
Practice Address - Country:US
Practice Address - Phone:715-207-1134
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-07
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF100973628OtherMEDICARE PTAN