Provider Demographics
NPI:1912286576
Name:PREFERRED EMERGENCY PHYSICIANS OF ILLINOIS, LLC
Entity type:Organization
Organization Name:PREFERRED EMERGENCY PHYSICIANS OF ILLINOIS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SISTER DIANE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MCGREW
Authorized Official - Suffix:
Authorized Official - Credentials:OSF
Authorized Official - Phone:309-655-2850
Mailing Address - Street 1:800 NE GLEN OAK AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61603-3255
Mailing Address - Country:US
Mailing Address - Phone:309-655-2850
Mailing Address - Fax:
Practice Address - Street 1:600 S 13TH ST
Practice Address - Street 2:
Practice Address - City:PEKIN
Practice Address - State:IL
Practice Address - Zip Code:61554-4936
Practice Address - Country:US
Practice Address - Phone:309-347-1151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OSF HEALTHCARE SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-08-12
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty