CARDINAL MEDICAL GROUP, LTD. (NPI# 1992829485) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1992829485 |
| Entity Type | Organization |
| Organization Name | CARDINAL MEDICAL GROUP, LTD. |
| Practice Address |
6339 N Big Hollow Rd Peoria IL 61615-2907 |
| Practice Telephone | 3096933315 |
| Practice Fax Number | 3096939385 |
| Mailing Telephone | 3096933315 |
| Mailing Fax Number | 3096939385 |
| Enumeration Date | 2007-03-19 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MR. MICHAEL A SHADLEY (ADMINISTRATOR) |
| Authorized Official Telephone | 3096938611 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM1300X |
Clinic/Center Specialization: Multi-Specialty |
IL | Ambulatory Health Care Facilities |
| Street Address |
6339 N BIG HOLLOW RD |
| City | PEORIA |
| State | IL |
| Zip Code | 61615-2907 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841261872 | Allen Lynn Neese | Pediatrics | 6339 N Big Hollow Rd, Peoria, IL 61615-2908 | 2006-01-28 |
| 1356826309 | Amanda Lynn Lahood | Nurse Practitioner | 6339 N Big Hollow Rd, Peoria, IL 61615-2907 | 2018-09-26 |
| 1053831214 | Holly Vannitamby | Internal Medicine | 6339 N Big Hollow Rd, Peoria, IL 61615-2907 | 2017-06-20 |
| 1205928397 | Henry Anthony San German | Family Medicine | 6339 N Big Hollow Rd, Peoria, IL 61615-2907 | 2006-09-28 |
| 1306819289 | Heather Lee Doebler Mccarthy | Pediatrics | 6339 N Big Hollow Rd, Peoria, IL 61615-2908 | 2006-02-09 |
| 1336111897 | Leslie E Johnson | Family Medicine | 6339 N Big Hollow Rd, Peoria, IL 61615-2908 | 2006-02-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124627906 | Lance Jay Bucher | Occupational Therapist | 8600 Il-91, Peoria, IL 61615 | 2020-10-22 |
| 1093327496 | Angela Mitchell | Speech-Language Pathologist | 3903 W Ridgeview Dr, Peoria, IL 61615 | 2020-08-18 |
| 1578110680 | Emily E Buenting | Audiologist | 8600 Il Route 91, Suite 300, Peoria, IL 61615 | 2019-08-22 |
| 1730655572 | Sylwia M. Budzik | Physician Assistant | 8600 Illinois Rt. 91, Suite 300, Peoria, IL 61615 | 2018-10-19 |
| 1487169207 | Heather Hart | Registered Nurse | 9016 N. Scrimshaw Dr. Apt 104, Peoria, IL 61615 | 2017-12-04 |
| 1528586849 | Leanne Runyon | Speech-Language Pathologist | 10723 Collett Dr., Peoria, IL 61615 | 2017-09-07 |
| 1467974196 | Elizabeth A Mcleod | Nurse Practitioner | 8600 Illinois Route 91, Suite 130, Peoria, IL 61615 | 2017-07-14 |
| 1790223022 | Janet Warner | Counselor | 8914 North Prarie Court, Peoria, IL 61615 | 2017-02-07 |
| 1437524022 | Brooke Bisping | Dietitian, Registered | 7610 North Orange Prairie Road, Peoria, IL 61615 | 2015-12-08 |
| 1003292111 | Crystal Ann Casper | Dietitian, Registered | 7610 N Orange Prarie Road, Peoria, IL 61615 | 2015-07-31 |
| Find all providers in zip 61615 | ||||
| Taxonomy Code | 261QM1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Multi-Specialty |
| Definition to come... |
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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.