Provider Demographics
NPI:1932831427
Name:VISIDOC, LLC
Entity Type:Organization
Organization Name:VISIDOC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:SEDGWICK
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:309-699-4715
Mailing Address - Street 1:111 W WASHINGTON ST STE 310
Mailing Address - Street 2:
Mailing Address - City:EAST PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61611-2559
Mailing Address - Country:US
Mailing Address - Phone:309-699-4715
Mailing Address - Fax:
Practice Address - Street 1:111 W WASHINGTON ST STE 310
Practice Address - Street 2:
Practice Address - City:EAST PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61611-2559
Practice Address - Country:US
Practice Address - Phone:309-699-4715
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-24
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care