Provider Demographics
NPI:1851776025
Name:JOSEPH & HISHON INTEGRATED HEALTH CENTER LTD
Entity Type:Organization
Organization Name:JOSEPH & HISHON INTEGRATED HEALTH CENTER LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEATH
Authorized Official - Middle Name:
Authorized Official - Last Name:HISHON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-693-2225
Mailing Address - Street 1:5001 N UNIVERSITY ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-4799
Mailing Address - Country:US
Mailing Address - Phone:309-693-2225
Mailing Address - Fax:309-693-2228
Practice Address - Street 1:5001 N UNIVERSITY ST
Practice Address - Street 2:SUITE A
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-4799
Practice Address - Country:US
Practice Address - Phone:309-693-2225
Practice Address - Fax:309-693-2228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-29
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF100270416Medicare PIN