Provena Service Corporation

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

Legal business name

PROVENA SERVICE CORPORATION

Doing business as

Provena Medical Group

Practice address

102 N Logan Ave
Danville, IL 61832-8513

Phone

(217) 442-5863

Fax

(217) 442-5040

NPI assigned

Sep 10, 2007

Last updated

Apr 20, 2008By the provider in NPPES

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

Daniel Boland

Title

Financial Reporting Manager

Phone

(815) 806-3111

Specialties & licenses 1

Addresses

Other names 1

• Provena Medical Group Doing business as

Part of

Provena Service Corp

Member of 1

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

• Mercy Medical Center - Aurora LLC

  dba Prime Healthcare Rx 1005

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

  Member Of

  NPD member

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

{
    "created_epoch": "1189382400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1255526687",
    "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": "102 N LOGAN AVE",
            "city": "DANVILLE",
            "state": "IL",
            "postal_code": "618328513",
            "telephone_number": "217-442-5863",
            "fax_number": "217-442-5040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVENA SERVICE CORPORATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PROVENA SERVICE CORPORATION",
        "enumeration_date": "2007-09-10",
        "last_updated": "2008-04-20",
        "status": "A",
        "authorized_official_last_name": "BOLAND",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_title_or_position": "FINANCIAL REPORTING MANAGER",
        "authorized_official_telephone_number": "815-806-3111"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Provena Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Professional Physical Therapy, P.C.
• Professional Physical Therapy, PC
• Maxwell Prosser, OD
• Provena Hospitals (Pusmc Physician Billing)
• Provena Service Corporation (Provena Medical Group)
• Ashley Lauren Pruemer, COTA
• Megan Purcell
• Margaret L Quick
• Nirmala Rajeswaren, M.D.
• Raj Rajeswaren, MD

• Pediatrics Physician in Danville, IL
• Providers in Danville, IL by specialty
• Pediatrics 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.