Provider Demographics
NPI:1851305262
Name:OTTAWA OSTEOPATHIC PHYSICIANS, LTD.
Entity Type:Organization
Organization Name:OTTAWA OSTEOPATHIC PHYSICIANS, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:LOVE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:815-434-1977
Mailing Address - Street 1:645 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:IL
Mailing Address - Zip Code:61350
Mailing Address - Country:US
Mailing Address - Phone:815-434-1977
Mailing Address - Fax:815-434-2022
Practice Address - Street 1:645 W MAIN ST
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:IL
Practice Address - Zip Code:61350
Practice Address - Country:US
Practice Address - Phone:815-434-1977
Practice Address - Fax:815-434-2022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILDV3801OtherPALMETTO GBA
IL5020224OtherBCBS IL
ILDV3801OtherPALMETTO GBA