Soderstrom Dermatology Center S C

LBN: Soderstrom Dermatology Center S C
Soderstrom Dermatology Center S C is an health care organization with primary practice located at 4909 N Glen Park Place Rd , Peoria IL 61614-4676. The organization recently has 6 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Dermatology, Allopathic & Osteopathic Physicians / MOHS-Micrographic Surgery, Allopathic & Osteopathic Physicians / Dermatopathology, Allopathic & Osteopathic Physicians / Procedural Dermatology, Allopathic & Osteopathic Physicians / Plastic Surgery, Allopathic & Osteopathic Physicians / Surgery. Allopathic & Osteopathic Physicians / Dermatology is the primary health care specialty. Soderstrom Dermatology Center S C can be contacted via phone (309) 674-7546, or through Peugh, Christina M via phone (309) 674-7546.

Contact Information

Primary practice address
4909 N Glen Park Place Rd Peoria IL 61614-4676
Phone: (309) 674-7546
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Peugh, Christina M MBA
Phone: (309) 674-7546

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Dermatology 207N00000X
Allopathic & Osteopathic Physicians / MOHS-Micrographic Surgery 207ND0101X
Allopathic & Osteopathic Physicians / Dermatopathology 207ND0900X
Allopathic & Osteopathic Physicians / Procedural Dermatology 207NS0135X
Allopathic & Osteopathic Physicians / Dermatopathology 207ZD0900X
Allopathic & Osteopathic Physicians / Plastic Surgery 208200000X
Allopathic & Osteopathic Physicians / Surgery 208600000X

Profile Details

NPI number 1710931670
LBN Legal business name Soderstrom Dermatology Center S C
DBA Doing business as
Authorized official Peugh, Christina M MBA
Entity Organization
Organization subpart 1 No
Enumeration date May 22nd, 2006
Last updated Apr 8th, 2008 - about 17 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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