Provider Demographics
NPI:1932449691
Name:J&J HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:J&J HEALTH SERVICES LLC
Other - Org Name:MENS HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:BANNO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:309-621-4770
Mailing Address - Street 1:7309 N KNOXVILLE AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-2085
Mailing Address - Country:US
Mailing Address - Phone:309-672-1477
Mailing Address - Fax:
Practice Address - Street 1:7309 N KNOXVILLE AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-2085
Practice Address - Country:US
Practice Address - Phone:309-672-1477
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-18
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036053979208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty