Peoria Weightloss, LLC

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

Legal business name

PEORIA WEIGHTLOSS, LLC

Practice address

2426 W Cornerstone CT Ste 100
Peoria, IL 61614-2400

Phone

(309) 966-3137

NPI assigned

May 8, 2013

Last updated

May 8, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Kurtis Freidag

Title

Owner

Phone

(309) 966-3137

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1367971200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1367971200000",
    "number": "1912342569",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2426 W CORNERSTONE CT STE 100",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616142400",
            "telephone_number": "309-966-3137"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2426 W CORNERSTONE CT STE 100",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616142400",
            "telephone_number": "309-966-3137"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEORIA WEIGHTLOSS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-05-08",
        "last_updated": "2013-05-08",
        "status": "A",
        "authorized_official_last_name": "FREIDAG",
        "authorized_official_first_name": "KURTIS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "309-966-3137",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Peoria Specialty, Inc.
• Peoria Spine and Sport LTD.
• Peoria Surgical Group, LTD.
• Peoria Tazewell Pathology Group, S.C.
• Peoria Urological Associates S.C
• Kurt Michael Pepperell, D.C,
• Troy Pequette
• Krystal Darnell Perdue, NP
• Diogenes Leslie Perera
• Lynsey Perera

• Medical Specialty Clinic/Center in Peoria, IL
• Providers in Peoria, IL by specialty
• Medical Specialty Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2013; 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.