Provider Demographics
NPI:1346000361
Name:DESIRED MEDICAL SERVICES 2 LLC
Entity Type:Organization
Organization Name:DESIRED MEDICAL SERVICES 2 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MGR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:855-276-5212
Mailing Address - Street 1:7820 N UNIVERSITY ST STE 110
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-8301
Mailing Address - Country:US
Mailing Address - Phone:708-394-3296
Mailing Address - Fax:
Practice Address - Street 1:7820 N UNIVERSITY ST STE 110
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-8301
Practice Address - Country:US
Practice Address - Phone:708-394-3296
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty