Provider Demographics
NPI:1437697307
Name:BAYVIEW FAMILY CLINIC LTD
Entity Type:Organization
Organization Name:BAYVIEW FAMILY CLINIC LTD
Other - Org Name:DANVILLE PEDITRICS AND FAMILY CENTRE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LINUS
Authorized Official - Middle Name:UCHECHUKWU
Authorized Official - Last Name:ANUKWU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:217-530-2106
Mailing Address - Street 1:405 SHERIDAN ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61832-4451
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:405 SHERIDAN ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832-4451
Practice Address - Country:US
Practice Address - Phone:217-446-3259
Practice Address - Fax:217-446-4132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-10
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209015479305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========OtherEIN