Provider Demographics
NPI:1902059215
Name:MEMORIAL HEALTH VENTURES
Entity Type:Organization
Organization Name:MEMORIAL HEALTH VENTURES
Other - Org Name:SPORTSCARE OF ILLINOIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT, BUSINESS DEVELOPMEN
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ENGLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-788-3851
Mailing Address - Street 1:PO BOX 3428
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62708-3428
Mailing Address - Country:US
Mailing Address - Phone:800-577-5368
Mailing Address - Fax:217-757-2021
Practice Address - Street 1:100 CHATHAM RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-1533
Practice Address - Country:US
Practice Address - Phone:217-862-0444
Practice Address - Fax:217-546-3584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-30
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy