SODERSTROM DERMATOLOGY CENTER S C (NPI# 1053362343) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053362343 |
| Entity Type | Organization |
| Organization Name | SODERSTROM DERMATOLOGY CENTER S C |
| Other Organization Name | PEORIA AMBULATORY SURGERY CENTER |
| Practice Address |
4909 N Glen Park Place Rd Peoria IL 61614-4676 |
| Practice Telephone | 3096906012 |
| Mailing Telephone | 3096906012 |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2008-06-25 |
| Authorized Official Name | TINA M PEUGH (EXECUTIVE DIRECTOR, SODERSTROM DERM) |
| Authorized Official Telephone | 3096747546 |
| Authorized Official Credential | MBA |
| Is Organization Subpart | Y |
| Parent Organization Name | SODERSTROM DERMATOLOGY CENTER S C |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QA1903X |
Clinic/Center Specialization: Ambulatory Surgical |
7001530 | IL | Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Peoria Ambulatory Surgery Center | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710931670 | Soderstrom Dermatology Center S C | Pathology | 4909 N Glen Park Place Rd, Peoria, IL 61614-4676 | 2006-05-22 |
| Street Address |
4909 N GLEN PARK PLACE RD |
| City | PEORIA |
| State | IL |
| Zip Code | 61614-4676 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174599260 | Chen Wang | Pathology | 4909 N Glen Park Place Rd, Peoria, IL 61614-4676 | 2006-02-27 |
| 1790180164 | Sara Snarr | Nurse Practitioner | 4909 N Glen Park Place Rd, Peoria, IL 61614-4676 | 2014-10-28 |
| 1700209160 | Sarah Christensen | Physician Assistant | 4909 N Glen Park Place Rd, Peoria, IL 61614-4676 | 2014-01-21 |
| 1134481054 | Nour Almardini | Pathology | 4909 N Glen Park Place Rd, Peoria, IL 61614-4689 | 2012-06-15 |
| 1922313238 | Stephanie M Ellis | Physician Assistant | 4909 N Glen Park Place Rd, Peoria, IL 61614-4676 | 2010-08-11 |
| 1245490382 | Tesfu Hailu | Dermatology | 4909 N Glen Park Place Rd, Peoria, IL 61614-4676 | 2008-06-12 |
| 1477743813 | Michelle L Roth | Physician Assistant | 4909 N Glen Park Place Rd, Peoria, IL 61614-4676 | 2007-08-01 |
| 1073655676 | James Murray Jeffries IIi | Surgery | 4909 N Glen Park Place Rd, Peoria, IL 61614-4676 | 2007-02-12 |
| 1912017245 | Michael L Hayes | Dermatology | 4909 N Glen Park Place Rd, Peoria, IL 61614-4676 | 2006-08-30 |
| 1871506931 | John R Soderstrom | Physician Assistant | 4909 N Glen Park Place Rd, Peoria, IL 61614-4676 | 2006-08-13 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548818511 | Christine Svoboda | Social Worker | 6919 N Knoxville Ave Ste 100 and 202, Peoria, IL 61614 | 2019-09-03 |
| 1639649007 | Kathy Karouzos Counseling, LLC | Clinic/Center | 330 W. Ivy Ln., Peoria, IL 61614 | 2018-11-28 |
| 1205312790 | Kathleen Marie Hendricks | Nurse Practitioner | 2809 W Willow Knolls Dr, Peoria, IL 61614 | 2018-07-17 |
| 1629563937 | Mary Elizabeth Cunningham | Counselor | 6219 N. Eldorado Dr., Peoria, IL 61614 | 2018-06-28 |
| 1861937955 | Angela Gilles | Social Worker | 6919 N Knoxville Ave Ste 100, Peoria, IL 61614 | 2016-12-27 |
| 1467994897 | Melissa Saxsma | Specialist | 5009 N Executive Dr, Peoria, IL 61614 | 2016-11-16 |
| 1902258874 | Rashid Plastic Surgery, LLC | Plastic Surgery | 804 W Trailcreek Drive, Peoria, IL 61614 | 2016-07-05 |
| 1215313143 | Melissa Lynn Phelan | Nurse Practitioner | 122 E Morningside Dr, Peoria, IL 61614 | 2015-08-03 |
| 1811380165 | All Ways Caring Services, Inc. | In Home Supportive Care | 6919 N Knoxville Ave, Suite 102, Peoria, IL 61614 | 2015-03-11 |
| 1568875920 | Schuler & Arkwell Orthodontic Partnership | Dentist | 2425 Cornerstone Ct. Ste. A, Peoria, IL 61614 | 2014-06-03 |
| Find all providers in zip 61614 | ||||
| Taxonomy Code | 261QA1903X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Ambulatory Surgical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104341353 | Banner Peoria Surgery Center LLC | Clinic/Center | 13640 N Plaza Del Rio Blvd Ste 135, Peoria, AZ 85381-4846 | 2017-08-09 |
| 1285085068 | Valley Pain Centers of Arizona, LLC | Clinic/Center | 9242 W Union Hills Dr Ste 100, Peoria, AZ 85382-8218 | 2016-06-23 |
| 1700137650 | Olive Surgical Care, LLC | Clinic/Center | 8914 N 91st Ave, Suite 120, Peoria, AZ 85345-8390 | 2012-10-01 |
| 1972782845 | Nationalhealthcareinc | Clinic/Center | 7405 N University St, Peoria, IL 61614-1212 | 2007-10-29 |
| 1104957869 | Pain Solutions Center, LLC | Clinic/Center | 15262 N 75th Ave, Suite 400, Peoria, AZ 85381-4763 | 2007-03-07 |
| 1821141284 | Center for Health Ambulatory Surgery Center, LLC | Clinic/Center | 8800 Route 91 North, Peoria, IL 61615 | 2007-01-19 |
| 1528002219 | Pinnacle Surgery Center LLC | Clinic/Center | 6790 W Thunderbird Rd, Peoria, AZ 85381-5023 | 2006-06-15 |
| 1518498385 | Annmarie Klein | Clinic/Center | 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2017-03-23 |
| 1023567260 | Ski Ambulatory Surgical Centers, LLC | Clinic/Center | 7362 W Thunderbird Rd, Suite 103, Peoria, AZ 85381-5028 | 2016-09-29 |
| 1790104248 | Metro Surgery Center, LLC | Clinic/Center | 6790 W Thunderbird Rd, Peoria, AZ 85381 | 2014-04-14 |
| Find all providers in PEORIA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.