Provider Demographics
NPI:1386802775
Name:CENTRAL ILLINOIS NERVE TESTING LTD
Entity type:Organization
Organization Name:CENTRAL ILLINOIS NERVE TESTING LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:RUFF
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:309-691-1727
Mailing Address - Street 1:614 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61603-4133
Mailing Address - Country:US
Mailing Address - Phone:309-637-3668
Mailing Address - Fax:309-637-2325
Practice Address - Street 1:3322 W WILLOW KNOLLS RD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-8148
Practice Address - Country:US
Practice Address - Phone:309-691-1727
Practice Address - Fax:309-637-2325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-02
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016003701213EP1101X, 302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
No302F00000XManaged Care OrganizationsExclusive Provider OrganizationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1114926748OtherCURTIS WARD, DPM
IL1093885378OtherMARK SMITH, DPM
IL1083613293OtherANTHONY V DECEANNE DPM
IL1285613463OtherT. KEVIN BRATTAIN, DPM
IL1093885378OtherMARK SMITH, DPM
IL016003701Medicare UPIN
IL1015930001Medicare NSC