Organization · NPI-2

15 Park Place LLC

Internal Medicine · Swansea, IL

NPI number1447870274
StatusActive
Last updated in NPPESJul 8, 2020

Details

NPI
1447870274
Entity type
Organization (NPI-2)
Legal business name
15 Park Place LLC
Organization subpart
No
Enumeration date
Apr 22, 2020
Certification date
Jul 8, 2020
Last updated
Jul 8, 2020

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207R00000X Internal Medicine––Yes
363LP2300X Nurse Practitioner, Primary Care––

Other names

  • Adult Internal Medicine Office Practice (Doing Business As)

Practice location

15 Park Pl Ste 1
Swansea, IL 62226-2918

Phone 618-580-1359 · Fax 618-234-7242

Mailing address

15 Park Pl Ste 1
Swansea, IL 62226-2918

Phone 618-580-1359 · Fax 618-234-7242

Authorized official

Clara Ampadu
Ceo
6185801359

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