Provider Demographics
NPI:1033308242
Name:TERRILL M BANER M.D., LTD
Entity Type:Organization
Organization Name:TERRILL M BANER M.D., LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-762-1488
Mailing Address - Street 1:608 35TH AVE
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-6145
Mailing Address - Country:US
Mailing Address - Phone:309-762-1488
Mailing Address - Fax:309-792-9745
Practice Address - Street 1:608 35TH AVE
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-6145
Practice Address - Country:US
Practice Address - Phone:309-762-1488
Practice Address - Fax:309-792-9745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-24
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL0101OtherUHC OF THE RIVER VALLEY
IL08100333OtherBLUE CROSS BLUE SHIELD
IL08100333OtherBLUE CROSS BLUE SHIELD
ILIL0101OtherUHC OF THE RIVER VALLEY