Provider Demographics
NPI:1467837302
Name:WHOLE WOMANS HEALTH OF PEORIA LLC
Entity Type:Organization
Organization Name:WHOLE WOMANS HEALTH OF PEORIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:JEANNE
Authorized Official - Last Name:FRANK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-790-7331
Mailing Address - Street 1:7405 N UNIVERSITY ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-1212
Mailing Address - Country:US
Mailing Address - Phone:309-332-1622
Mailing Address - Fax:
Practice Address - Street 1:7405 N UNIVERSITY ST
Practice Address - Street 2:SUITE D
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-1212
Practice Address - Country:US
Practice Address - Phone:309-332-1622
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-21
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILHF108540261QA0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility