Provider Demographics
NPI:1205933736
Name:VERMILION MEDICAL CENTER LTD
Entity type:Organization
Organization Name:VERMILION MEDICAL CENTER LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:RUBIO
Authorized Official - Last Name:OCHOA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:217-443-3866
Mailing Address - Street 1:701 WEST FAIRCHILD STREET
Mailing Address - Street 2:SUITE A
Mailing Address - City:DANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61832
Mailing Address - Country:US
Mailing Address - Phone:217-443-3866
Mailing Address - Fax:217-443-0216
Practice Address - Street 1:701 WEST FAIRCHILD STREET
Practice Address - Street 2:SUITE A
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832
Practice Address - Country:US
Practice Address - Phone:217-443-3866
Practice Address - Fax:217-443-0216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Not Answered208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
D10643Medicare UPIN