Provider Demographics
NPI:1508867557
Name:EAGLE FAMILY MEDICINE SC
Entity Type:Organization
Organization Name:EAGLE FAMILY MEDICINE SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:BEVILL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:309-446-3305
Mailing Address - Street 1:111 E KNOXVILLE ST
Mailing Address - Street 2:
Mailing Address - City:BRIMFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:61517-8022
Mailing Address - Country:US
Mailing Address - Phone:309-446-3305
Mailing Address - Fax:309-446-9072
Practice Address - Street 1:111 E KNOXVILLE ST
Practice Address - Street 2:
Practice Address - City:BRIMFIELD
Practice Address - State:IL
Practice Address - Zip Code:61517-8022
Practice Address - Country:US
Practice Address - Phone:309-446-3305
Practice Address - Fax:309-446-9072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK37812OtherMEDICARE PROVIDER NUMBER
IL208745OtherMEDICARE GROUP NUMBER
ILC48132Medicare UPIN