Peoria Specialty, Inc.

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

203.000663 Issued in IL

Legal business name

PEORIA SPECIALTY, INC.

Practice address

610 Abington St Ste I
Peoria, IL 61603-3577

Phone

(309) 693-4459

Fax

(309) 693-5801

NPI assigned

Sep 20, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Scott M Wood

Title

Vice President

Phone

(309) 693-4459

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1618963200000",
    "number": "1104923499",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "610 ABINGTON ST STE I",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616033577",
            "telephone_number": "309-693-4459",
            "fax_number": "309-693-5801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "610 ABINGTON ST STE I",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616033577",
            "telephone_number": "309-693-4459",
            "fax_number": "309-693-5801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEORIA SPECIALTY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2021-04-21",
        "certification_date": "2021-04-21",
        "status": "A",
        "authorized_official_last_name": "WOOD",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "309-693-4459",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "IL",
            "license": "203.000663",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Durable Medical Equipment & Medical Supplies in Peoria, IL
• Providers in Peoria, IL by specialty
• Durable Medical Equipment & Medical Supplies in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.