Danville Polyclinic, LTD

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

License

060000812 Issued in IL

Legal business name

DANVILLE POLYCLINIC, LTD

Practice address

707 N Logan Ave
Danville, IL 61832-4360

Phone

(217) 446-6410

Fax

(217) 477-4757

NPI assigned

Jun 12, 2006

Organization subpart

No

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

Authorized official

Name

Ms. Melissa A Edington

Title

Administrator

Phone

(217) 477-4750

Specialties & licenses 1

Addresses

Other identifiers 4

Locations

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

{
    "created_epoch": "1150070400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1227571200000",
    "number": "1336181544",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "707 N LOGAN AVE",
            "city": "DANVILLE",
            "state": "IL",
            "postal_code": "618324360",
            "telephone_number": "217-446-6410",
            "fax_number": "217-477-4757"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "707 N LOGAN AVE",
            "city": "DANVILLE",
            "state": "IL",
            "postal_code": "618324360",
            "telephone_number": "217-446-6410",
            "fax_number": "217-477-4757"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DANVILLE POLYCLINIC, LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-12",
        "last_updated": "2008-11-25",
        "status": "A",
        "authorized_official_last_name": "EDINGTON",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "217-477-4750",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "IL",
            "license": "060000812",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100002020A",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLACK LUNG",
            "identifier": "221069",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF ILLINOIS",
            "identifier": "09215807",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UMWA",
            "identifier": "1486765",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Danville Operations LLC
• Danville Pain & Rehabilitation Medicine Center, LLC
• Danville Pain Management and Rehabilitation Institute, LLC.
• Danville Pediatric Center
• Danville Polyclinic LTD
• Danville Polyclinic, LTD
• Danville Vamc
• Danville Vamc
• Margie L Dash, M.S.
• Matthew Steven Daugherty, DDS

• Multi-Specialty Clinic/Center in Danville, IL
• Providers in Danville, IL by specialty
• Multi-Specialty Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 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.