Provider Demographics
NPI:1386764033
Name:CENTRAL ILLINOIS ARTHRITIS AND REHABILITATION CENTER PC
Entity type:Organization
Organization Name:CENTRAL ILLINOIS ARTHRITIS AND REHABILITATION CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DARYL
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:309-353-5921
Mailing Address - Street 1:19 OLT AVE
Mailing Address - Street 2:
Mailing Address - City:PEKIN
Mailing Address - State:IL
Mailing Address - Zip Code:61554-6216
Mailing Address - Country:US
Mailing Address - Phone:309-353-5921
Mailing Address - Fax:309-353-6872
Practice Address - Street 1:19 OLT AVE
Practice Address - Street 2:
Practice Address - City:PEKIN
Practice Address - State:IL
Practice Address - Zip Code:61554-6216
Practice Address - Country:US
Practice Address - Phone:309-353-5921
Practice Address - Fax:309-353-6872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL09032039OtherBLUE CROSS BLUE SHIELD
ILDB6931OtherMEDICARE RAILROAD
IL206943Medicare PIN