Provider Demographics
NPI:1326253873
Name:FLEMING OBSTETRICAL & GYNECOLOGICAL SERVICES LTD
Entity Type:Organization
Organization Name:FLEMING OBSTETRICAL & GYNECOLOGICAL SERVICES LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SPECIALIST
Authorized Official - Prefix:MS
Authorized Official - First Name:KANDY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:POLLITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-673-6791
Mailing Address - Street 1:900 MAIN STREET
Mailing Address - Street 2:SUITE 360
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61602-5017
Mailing Address - Country:US
Mailing Address - Phone:309-673-3743
Mailing Address - Fax:
Practice Address - Street 1:900 MAIN ST
Practice Address - Street 2:SUITE 360
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61602-5017
Practice Address - Country:US
Practice Address - Phone:309-673-3743
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL07232161OtherBLUECROSS BLUESHIELD
IL07232161OtherBLUECROSS BLUESHIELD