NPIMap

Organization Active NPI

Rejuv Champaign PC

  • Clinic/Center
  • Champaign, IL
National Provider Identifier
1356601629
Registry record updated May 21, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
209005824 Issued in IL
Legal business name
REJUV CHAMPAIGN PC
Practice address
606 North County Fair Drive
A
Champaign, IL 61820
Phone
(217) 607-0762
NPI assigned
May 21, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 21, 2012

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

Authorized official

Name
Shawn Christopher Snider, CNP
Title
Owner
Phone
(309) 678-4243

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X 209005824 IL Primary

Addresses

Primary practice location

606 North County Fair Drive
A
Champaign, IL 61820

Mailing address

405 N Hershey Rd
Bloomington, IL 61704-3527
Phone (309) 662-3002

National Provider Directory

National Provider Directory
Tax ID family
Rejuv Bloomington2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

405 N Hershey Rd
Bloomington, IL 61704
Phone (309) 622-3002

NPI Registry JSON

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

{
    "created_epoch": "1337558400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1337558400000",
    "number": "1356601629",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "405 N HERSHEY RD",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617043527",
            "telephone_number": "309-662-3002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "606 NORTH COUNTY FAIR DRIVE",
            "address_2": "A",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "61820",
            "telephone_number": "217-607-0762"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REJUV CHAMPAIGN PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-21",
        "last_updated": "2012-05-21",
        "status": "A",
        "authorized_official_last_name": "SNIDER",
        "authorized_official_first_name": "SHAWN",
        "authorized_official_middle_name": "CHRISTOPHER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "309-678-4243",
        "authorized_official_credential": "CNP"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "IL",
            "license": "209005824",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Champaign, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2012; 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.