Rejuv Peoria PC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

IL036086752 Issued in IL

Legal business name

REJUV PEORIA PC

Practice address

501 N Morton Ave
Morton, IL 61550-1526

Phone

(309) 263-4673

Fax

(309) 263-4611

NPI assigned

May 18, 2012

Organization subpart

No

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

Addresses

Locations

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

{
    "created_epoch": "1337299200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1337299200000",
    "number": "1801156377",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 N MORTON AVE",
            "city": "MORTON",
            "state": "IL",
            "postal_code": "615501526",
            "telephone_number": "309-263-4673"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 N MORTON AVE",
            "city": "MORTON",
            "state": "IL",
            "postal_code": "615501526",
            "telephone_number": "309-263-4673",
            "fax_number": "309-263-4611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REJUV PEORIA PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-18",
        "last_updated": "2012-05-18",
        "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": "IL036086752",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinic/Center in Morton, IL
• Providers in Morton, IL by specialty
• Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 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.