Provider Demographics
NPI:1639359797
Name:SPRINGFIELD OB/GYN GROUP LTD
Entity type:Organization
Organization Name:SPRINGFIELD OB/GYN GROUP LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANNE
Authorized Official - Middle Name:R
Authorized Official - Last Name:LUSINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-729-0330
Mailing Address - Street 1:301 SPRINGFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-6590
Mailing Address - Country:US
Mailing Address - Phone:815-729-0330
Mailing Address - Fax:815-729-0566
Practice Address - Street 1:301 SPRINGFIELD AVE
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-6590
Practice Address - Country:US
Practice Address - Phone:815-729-0330
Practice Address - Fax:815-729-0566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-06
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL09908558OtherBCBS
IL1922161827OtherINDIVIDUAL NPI
IL=========OtherTAX ID
IL395411Medicare PIN
IL1922161827OtherINDIVIDUAL NPI