Provider Demographics
NPI:1003857061
Name:CENTRAL ILLINOIS RADIATION ONCOLOGY PHYSICIANS, LTD
Entity Type:Organization
Organization Name:CENTRAL ILLINOIS RADIATION ONCOLOGY PHYSICIANS, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REVATHI
Authorized Official - Middle Name:
Authorized Official - Last Name:SWAMINATHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:309-671-8749
Mailing Address - Street 1:108 SW MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61602-1107
Mailing Address - Country:US
Mailing Address - Phone:309-671-8749
Mailing Address - Fax:309-671-8740
Practice Address - Street 1:221 NE GLEN OAK AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61636-0001
Practice Address - Country:US
Practice Address - Phone:309-672-5700
Practice Address - Fax:309-671-2774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE7037OtherRAILROAD GROUP NUMBER
DE7037OtherRAILROAD GROUP NUMBER