Peoria Integrative Medical Center LTD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

036114042 Issued in IL

Legal business name

PEORIA INTEGRATIVE MEDICAL CENTER LTD

Practice address

4930 N Executive Dr
Suite B
Peoria, IL 61614-4894

Phone

(309) 683-6002

Fax

(309) 683-6007

NPI assigned

Dec 20, 2006

Organization subpart

No

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

Authorized official

Name

Yang Xie, M.D.

Title

Owner

Phone

(309) 636-7302

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1166572800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1240185600000",
    "number": "1699839985",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4930 N EXECUTIVE DR",
            "address_2": "SUITE B",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616144894",
            "telephone_number": "309-683-6002",
            "fax_number": "309-683-6007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4930 N EXECUTIVE DR",
            "address_2": "SUITE B",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616144894",
            "telephone_number": "309-683-6002",
            "fax_number": "309-683-6007"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEORIA INTEGRATIVE MEDICAL CENTER LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-20",
        "last_updated": "2009-04-20",
        "status": "A",
        "authorized_official_last_name": "XIE",
        "authorized_official_first_name": "YANG",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "309-636-7302",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036114042",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036114042",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Peoria, IL
• Providers in Peoria, 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, 2009; 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.