NPIMap

Organization Active NPI

Greater Peoria Obstetrics & Gynecology Corp SC

  • Specialist
  • Peoria, IL
National Provider Identifier
1912129271
Registry record updated May 1, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
03658850 Issued in IL
Legal business name
GREATER PEORIA OBSTETRICS & GYNECOLOGY CORP SC
Practice address
4930 N Executive Dr
Peoria, IL 61614-4894
Phone
(309) 671-8749
Fax
(309) 671-8749
NPI assigned
May 3, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 1, 2015

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

Authorized official

Name
Judy Mueller
Title
Manager
Phone
(309) 692-7575

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X 03658850 IL Primary

Addresses

Primary practice location

4930 N Executive Dr
Peoria, IL 61614-4894

Mailing address

4930 N Executive Dr
Peoria, IL 61614-4894
Phone (309) 692-7575

Other identifiers 1

IdentifierTypeStateIssuer
212742OtherILMEDICARE GROUP NUMBER

National Provider Directory

National Provider Directory

Locations

211neglen Oak
Peoria, IL 61636
Phone (309) 671-8377

530neglen Oak
Peoria, IL 61636
Phone (309) 671-8377

NPI Registry JSON

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

{
    "created_epoch": "1178150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1430438400000",
    "number": "1912129271",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4930 N EXECUTIVE DR",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616144894",
            "telephone_number": "309-692-7575"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4930 N EXECUTIVE DR",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616144894",
            "telephone_number": "309-671-8749",
            "fax_number": "309-671-8749"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREATER PEORIA OBSTETRICS & GYNECOLOGY CORP SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-03",
        "last_updated": "2015-05-01",
        "status": "A",
        "authorized_official_last_name": "MUELLER",
        "authorized_official_first_name": "JUDY",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "309-692-7575"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "IL",
            "license": "03658850",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP NUMBER",
            "identifier": "212742",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2015; 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.