DECATUR DIGESTIVE DISEASE CENTER LLC (NPI# 1134185564) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1134185564 |
| Entity Type | Organization |
| Organization Name | DECATUR DIGESTIVE DISEASE CENTER LLC |
| Practice Address |
2 Memorial Dr Suite 102 Physician Plaza West Decatur IL 62526-3950 |
| Practice Telephone | 2172330003 |
| Practice Fax Number | 2172330077 |
| Mailing Telephone | 2172330003 |
| Mailing Fax Number | 2172330077 |
| Enumeration Date | 2006-04-25 |
| Last Update Date | 2013-04-01 |
| Authorized Official Name | VICTOR ELOY (MEDICAL DIRECTOR) |
| Authorized Official Telephone | 2172330003 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QA1903X |
Clinic/Center Specialization: Ambulatory Surgical |
7002983 | IL | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | MEDICARE RAILROAD | P00257307 | 01 |
| IL | BLUE CROSS BLUE SHIELD | 50402 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306802608 | Decatur Digestive Disease Center LLC | Nurse Anesthetist, Certified Registered | 2 Memorial Dr, Suite 102 Pysician Plaza West, Decatur, IL 62526-3950 | 2006-04-25 |
| Street Address |
2 MEMORIAL DR SUITE 102 PHYSICIAN PLAZA WEST |
| City | DECATUR |
| State | IL |
| Zip Code | 62526-3950 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083100804 | Coalition | Non-emergency Medical Transport (VAN) | 2375 N Longwood Dr, Decatur, IL 62526 | 2018-07-04 |
| 1881116820 | Bria N Howard | Nurse's Aide | 606 E Warren St. Apt 609, Decatur, IL 62526 | 2017-07-12 |
| 1437683679 | Lutheran Child and Family Services | Foster Care Agency | 2826 N. Monroe Street, Decatur, IL 62526 | 2017-04-14 |
| 1083166326 | Whitney Miller | Pharmacist | 225 East Ash Ave, Decatur, IL 62526 | 2016-11-03 |
| 1487053369 | Central Illinois Health Associates, Inc | Preferred Provider Organization | 2300 N. Edward Street, Decatur, IL 62526 | 2014-08-18 |
| 1659787893 | Stephanie Marie Kanitsch | Obstetrics & Gynecology | 544 W Pershing Rd Ste A, Decatur, IL 62526 | 2014-07-09 |
| 1497169973 | Brian Hassinger | Audiologist-Hearing Aid Fitter | 2605 N Water St Ste 101, Decatur, IL 62526 | 2014-06-12 |
| 1891041570 | Decatur 2016 LLC | Dentist | 141 Epershing Rd, Decatur, IL 62526 | 2012-07-31 |
| 1558639005 | Larry Lee Christensen | Pharmacist | 225 Ash Ave, Decatur, IL 62526 | 2011-12-12 |
| 1174821540 | Nathan Pyle | Internal Medicine | 2 Memorial Dr Ste 101, Decatur, IL 62526 | 2011-03-08 |
| Find all providers in zip 62526 | ||||
| Taxonomy Code | 261QA1903X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Ambulatory Surgical |
| Definition to come... |
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|---|---|---|---|---|
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| 1699328369 | Georgia Urology, Pa | Clinic/Center | 1670 Scott Blvd Ste 204k, Decatur, GA 30033-5645 | 2019-07-22 |
| 1568984375 | American Access Care of Atlanta Asc LLC | Clinic/Center | 250 E Ponce Deleon Avenue, Suite 100, Decatur, GA 30030-3406 | 2017-07-13 |
| 1194255372 | Decatur Urology Surgery Center | Clinic/Center | 2711 Irvin Way Ste 101, Decatur, GA 30030 | 2017-06-19 |
| 1962513788 | Surgery Center of Decatur Lp | Clinic/Center | 1122 14th Avenue Se, Decatur, AL 35601-3361 | 2006-08-31 |
| 1891716049 | Georgia Urology Ambulatory Surgical Center LLC | Clinic/Center | 2685 Milscott Dr, Decatur, GA 30033-5906 | 2006-07-22 |
| 1730601865 | Snapfinger Vascular Access Center Asc LLC | Clinic/Center | 5246 Snapfinger Park Dr, Decatur, GA 30035-4044 | 2017-07-11 |
| 1043660442 | Georgia Interventional Pain - D, LLC | Clinic/Center | 484 Irvin Ct, Suite 130, Decatur, GA 30030-5406 | 2016-06-16 |
| 1568705846 | Dekalb Center for Foot and Ankle Surgery, LLC | Clinic/Center | 215 Clairemont Ave, Decatur, GA 30030-2508 | 2013-04-04 |
| 1922262278 | Eps Surgical Center, LLC | Clinic/Center | 1457 Scott Blvd, Decatur, GA 30030-1425 | 2008-07-16 |
| Find all providers in DECATUR | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.