Provena Service Corporation

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

PROVENA SERVICE CORPORATION

Practice address

405 Sheridan St
Danville, IL 61832-4451

Phone

(217) 431-6330

NPI assigned

Sep 7, 2007

Organization subpart

Yes

Parent organization

PROVENA SERVICE CORPORATIONAs reported in NPPES

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

Authorized official

Name

Mr. Daniel Boland

Title

Financial Reporting Specialist

Phone

(815) 806-3111

Specialties & licenses 1

Addresses

Other names 1

• Provena Medical Group Doing business as

Part of

Provena Service Corpora

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Mercy Medical Center - Aurora LLC

  • Community/Retail Pharmacy
  • Aurora, IL
  • NPI 1215025762

  Member Of

  NPD member

Locations

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Linus Uchechukwu Anukwu, MD

  • Family Medicine Physician
  • Belleville, IL
  • NPI 1144242090
  NPD (past)
• Josephine Mante, M.D.

  • Adult Medicine Physician
  • Aurora, IL
  • NPI 1427105022
  NPD (past)
• Robert Permut, M.D.

  • Psychiatry Physician
  • Frankfort, IL
  • NPI 1285070201
  NPD (past)
• Ronald Michael, M.D.

  • Neurological Surgery Physician
  • Hammond, IN
  • NPI 1538248729

  Single Specialty

  NPD (past)
• Lezlie J Painovich, DO

  • Family Medicine Physician
  • Madison, WI
  • NPI 1922058205
  NPD (past)

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

{
    "created_epoch": "1189123200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1134314602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9223 W SAINT FRANCIS RD",
            "city": "FRANKFORT",
            "state": "IL",
            "postal_code": "604238330",
            "telephone_number": "815-806-3111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "405 SHERIDAN ST",
            "city": "DANVILLE",
            "state": "IL",
            "postal_code": "618324451",
            "telephone_number": "217-431-6330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVENA SERVICE CORPORATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PROVENA SERVICE CORPORATION",
        "enumeration_date": "2007-09-07",
        "last_updated": "2008-04-20",
        "status": "A",
        "authorized_official_last_name": "BOLAND",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_title_or_position": "FINANCIAL REPORTING SPECIALIST",
        "authorized_official_telephone_number": "815-806-3111",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Provena Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Pro-Active Wellness and Injury Centre
• Professional Physical Therapy, P.C.
• Professional Physical Therapy, PC
• Maxwell Prosser, OD
• Provena Hospitals
• Provena Service Corporation
• Ashley Lauren Pruemer, COTA
• Megan Purcell
• Margaret L Quick
• Nirmala Rajeswaren, M.D.

• Family Medicine Physician in Danville, IL
• Providers in Danville, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2008; 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.