Provider Demographics
NPI:1508073347
Name:CIWIRC ( CENTRAL ILLINOIS WORK INJURY RESOURCE CENTER )
Entity Type:Organization
Organization Name:CIWIRC ( CENTRAL ILLINOIS WORK INJURY RESOURCE CENTER )
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:P
Authorized Official - Last Name:DUVENDACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-497-0300
Mailing Address - Street 1:736 SW WASHINGTON ST STE 2A
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61602-1643
Mailing Address - Country:US
Mailing Address - Phone:309-497-0300
Mailing Address - Fax:309-497-0922
Practice Address - Street 1:736 SW WASHINGTON ST STE 2A
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61602-1643
Practice Address - Country:US
Practice Address - Phone:309-497-0300
Practice Address - Fax:309-497-0922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL284300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes284300000XHospitalsSpecial Hospital