Provider Demographics
NPI:1265431506
Name:TAZEWELL COUNTY RESOURCE CENTERS INC
Entity type:Organization
Organization Name:TAZEWELL COUNTY RESOURCE CENTERS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:HALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-347-7148
Mailing Address - Street 1:111 W WASHINGTON ST
Mailing Address - Street 2:SUITE 410
Mailing Address - City:EAST PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61611-2532
Mailing Address - Country:US
Mailing Address - Phone:309-698-4001
Mailing Address - Fax:309-698-9227
Practice Address - Street 1:111 W WASHINGTON ST
Practice Address - Street 2:SUITE 410
Practice Address - City:EAST PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61611-2532
Practice Address - Country:US
Practice Address - Phone:309-698-4001
Practice Address - Fax:309-698-9227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WL0500XEye and Vision Services ProvidersOptometristLow Vision RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1285633693Medicare ID - Type UnspecifiedNPI
U54649Medicare UPIN
ILK30680Medicare ID - Type Unspecified
ILT77768Medicare UPIN
IL214089Medicare ID - Type Unspecified
IL253002Medicare ID - Type Unspecified