Provena Service Corporation

NPI #1134314602 in Danville, Illinois

Provider Information

NPI Number: 1134314602
Entity Type: Organization
Organization Name: Provena Service Corporation
Subpart: Yes (part of a larger organization)
Parent Organization: PROVENA SERVICE CORPORATION
Primary Specialty: Family Medicine
Enumeration Date: Sep 7, 2007
Last Updated: Apr 20, 2008

Practice Location

Address: 405 SHERIDAN ST
City: Danville
State: Illinois
ZIP Code: 61832-4451
Phone: (217) 431-6330

Authorized Official

Name: MR. DANIEL BOLAND
Title: FINANCIAL REPORTING SPECIALIST
Phone: (815) 806-3111

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Family Medicine	207Q00000X	Primary

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