Prairieview GYN LLC

Primary specialty

Gynecology PhysicianTaxonomy code 207VG0400X

License

036110330 Issued in IL

Legal business name

PRAIRIEVIEW GYN LLC

Practice address

3929 Morgan TRL
Bourbonnais, IL 60914-4738

Phone

(815) 935-1315

NPI assigned

Jul 29, 2011

Organization subpart

No

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

Authorized official

Name

Dr. Degaulle G Haile

Title

Managing Member

Phone

(815) 935-1315

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1311897600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1311897600000",
    "number": "1376821025",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3929 MORGAN TRL",
            "city": "BOURBONNAIS",
            "state": "IL",
            "postal_code": "609144738"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3929 MORGAN TRL",
            "city": "BOURBONNAIS",
            "state": "IL",
            "postal_code": "609144738",
            "telephone_number": "815-935-1315"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRAIRIEVIEW GYN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-29",
        "last_updated": "2011-07-29",
        "status": "A",
        "authorized_official_last_name": "HAILE",
        "authorized_official_first_name": "DEGAULLE",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "815-935-1315",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "207VG0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology, Gynecology",
            "state": "IL",
            "license": "036110330",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Thomas M Potoski, LCPC
• Nicole Potts
• Christopher Thomas Powell, D.D.S.
• Kristen Powell
• Prairie River Counseling and Consulting, LLC
• Presence Hospitals PRV (Presence St. Mary's Cancer Center)
• Presence Life Connections (Presence Our Lady of Victory Nursing Home)
• Prime Healthcare Home Care LLC
• Provena Imaging Services Inc (Provena Health Center for Diagnostic Imaging)
• Provena St Marys Hospital

• Gynecology Physician in Bourbonnais, IL
• Providers in Bourbonnais, IL by specialty
• Gynecology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2011; 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.