Provider Demographics
NPI:1154623429
Name:COMPREHENSIVE EMERGENCY SOLUTIONS II SC
Entity type:Organization
Organization Name:COMPREHENSIVE EMERGENCY SOLUTIONS II SC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:SOWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:309-343-8131
Mailing Address - Street 1:401 SW WATER ST
Mailing Address - Street 2:SUITE #509
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61602-1571
Mailing Address - Country:US
Mailing Address - Phone:309-999-1091
Mailing Address - Fax:
Practice Address - Street 1:695 N KELLOGG ST
Practice Address - Street 2:
Practice Address - City:GALESBURG
Practice Address - State:IL
Practice Address - Zip Code:61401-2807
Practice Address - Country:US
Practice Address - Phone:309-343-8131
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-18
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILDR4766OtherRRMCARE
IL=========Medicaid
IL=========Medicaid