Seaboch, Richard S
Seaboch, Richard S is an individual health care provider with primary practice located at 5405 N Knoxville Ave , Peoria IL 61614. He recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Surgical, Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant. Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant is his primary health care specialty. Seaboch, Richard S can be contacted via phone (309) 691-4410.Contact Information
Primary practice address
5405 N Knoxville Ave
Peoria IL 61614
Phone: (309) 691-4410
Fax: (309) 589-2830
Website:
Health care specialties
Specialty | Code | License # | State |
---|---|---|---|
Physician Assistants & Advanced Practice Nursing Providers / Surgical | 363AS0400X | 085001201 | Illinois |
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant | 363A00000X | 085001201 | Illinois |
Profile Details
NPI number | 1043227846 |
---|---|
LBN Legal business name | Seaboch, Richard S |
Credentials | Physician Assistant (PA) |
Entity | Individual |
Sole proprietor 1 | No |
Enumeration date | Aug 2nd, 2006 |
Last updated | Aug 31st, 2010 - about 14 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
State | Type | Number | Issuer |
---|---|---|---|
All States | NPI | 1043227846 | NPPES |
Illinois | MEDICAID | 085001201 |
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