ILLINOIS VALLEY EAR, NOSE & THROAT ASSOCIATES, INC. (NPI# 1316163926) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1316163926 |
| Entity Type | Organization |
| Organization Name | ILLINOIS VALLEY EAR, NOSE & THROAT ASSOCIATES, INC. |
| Practice Address |
4231 Progress Blvd Ste 2 Peru IL 61354-1193 |
| Practice Telephone | 8152240082 |
| Practice Fax Number | 8152241071 |
| Mailing Telephone | 8152240082 |
| Mailing Fax Number | 8152241071 |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2020-01-22 |
| Authorized Official Name | DR. BULENT MAMIKOGLU (PHYSICIAN) |
| Authorized Official Telephone | 8152240082 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207Y00000X | Otolaryngology | Allopathic & Osteopathic Physicians | ||
| N | 207YX0901X |
Otolaryngology Specialization: Otology & Neurotology |
Allopathic & Osteopathic Physicians | ||
| Y | 261QM2500X |
Clinic/Center Specialization: Medical Specialty |
336-079161 | IL | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | 036117864-1 | 05 |
| Street Address |
4231 PROGRESS BLVD STE 2 |
| City | PERU |
| State | IL |
| Zip Code | 61354-1193 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043228349 | Bulent Mamikoglu | Allergy & Immunology | 4231 Progress Blvd Ste 2, Peru, IL 61354-1193 | 2006-08-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437750247 | Saida Samedova | Optometrist | 5255 Il-251, Peru, IL 61354 | 2020-11-06 |
| 1205469483 | Illinois Valley Community Hospital | Registered Nurse | 1403 Sixth Street, Peru, IL 61354 | 2020-02-17 |
| 1689228322 | Zhong Xue | Dentist | 5301 Il-251, Ste A, Peru, IL 61354 | 2019-07-31 |
| 1003281668 | Christopher Shane Smith | Physical Therapist | 1400 Midtown Road, Peru, IL 61354 | 2015-12-08 |
| 1770823197 | Muscle Pain Clinic Inc | Chiropractor | 4231 Progress Blvd Ste 4, Peru, IL 61354 | 2013-02-21 |
| 1306194451 | Vijaya Lakshmi Bathina | Dentist | 5301 Route 251, Peru, IL 61354 | 2012-08-21 |
| 1225305634 | Walgreens | Point of Service | 1033 Shooting Park Road, Peru, IL 61354 | 2011-11-30 |
| 1811293574 | Charles Riva | Physical Therapist | 4461 N. Progress Blvd., Peru, IL 61354 | 2011-01-28 |
| 1932403896 | Emerging Vision, Inc | Eyewear Supplier (Equipment, not the service) | 3940 Route 251, Peru Mall Suite F-1, Peru, IL 61354 | 2011-01-06 |
| 1457668170 | Illinois Valley Community Hospital | Nurse Practitioner | 5307 Route 251, Peru, IL 61354 | 2010-09-01 |
| Find all providers in zip 61354 | ||||
| Taxonomy Code | 261QM2500X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Medical Specialty |
| An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer). |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386005395 | Illinois Valley Community Hospital | Clinic/Center | 1305 6th St, Peru, IL 61354-2759 | 2016-03-18 |
| 1306207311 | Illinois Valley Community Hospital | Clinic/Center | 1305 6th St, Peru, IL 61354-2759 | 2016-03-18 |
| 1578929816 | Illinois Valley Community Hospital | Clinic/Center | 1305 6th St, Peru, IL 61354-2759 | 2015-12-31 |
| 1932440625 | Illinois Valley Community Hospital | Clinic/Center | 1305 6th St, Peru, IL 61354-2759 | 2013-03-06 |
| 1063683977 | Illinois Valley Community Hospital | Clinic/Center | 920 West St, Suite 216, Peru, IL 61354-2763 | 2008-03-19 |
| 1225214323 | David J Coynik, Md,pc | Clinic/Center | 4413 N. Progress Blvd., Peru, IL 61354-2763 | 2008-01-18 |
| 1245429380 | Illinois Valley Community Hospital | Clinic/Center | 710 Peoria St, Peru, IL 61354-3351 | 2007-10-15 |
| 1619166758 | Illinois Valley Community Hospital | Clinic/Center | 920 West St Bldg B, Peru, IL 61354-2763 | 2007-10-15 |
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| 1477181782 | Embassy Studios North | Clinic/Center | 6455 N Cicero Ave, Lincolnwood, IL 60712-3407 | 2020-03-31 |
| 1689226318 | Midway Spine and Joint Pain Physicians | Clinic/Center | 5720 S Pulaski Rd, Chicago, IL 60629-4435 | 2019-07-12 |
| 1215598891 | Vero Clinics | Clinic/Center | 1192 E Pershing Rd, Decatur, IL 62526-4753 | 2019-06-25 |
| 1497215933 | Activate Healthcare | Clinic/Center | 2010 N Damen Ave Unit F, Chicago, IL 60647-3286 | 2019-03-21 |
| 1033699467 | Healthpointe Medical Center Sc | Clinic/Center | 530 Fullerton Rd Ste B, Swansea, IL 62226-2970 | 2018-08-15 |
| 1740794882 | Highland Park Cvs, L.L.C. | Clinic/Center | 72 Airport Plz, Bethalto, IL 62010-1774 | 2017-11-28 |
| 1447764014 | Dr Courtney Drendel Inc | Clinic/Center | 515 Hamilton St # 100, Geneva, IL 60134-2138 | 2017-11-19 |
| 1699206599 | David M Conner M.d. | Clinic/Center | 9 Executive Woods Ct Ste 2, Swansea, IL 62226-2016 | 2017-03-22 |
| Find all providers with the same taxonomy | ||||
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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.