Provider Demographics
NPI:1538432075
Name:DR. DIONISIO DEGRACIA MD SC
Entity type:Organization
Organization Name:DR. DIONISIO DEGRACIA MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIONISIO
Authorized Official - Middle Name:U
Authorized Official - Last Name:DEGRACIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-764-3711
Mailing Address - Street 1:P.O. BOX 130
Mailing Address - Street 2:1314-10TH ST.
Mailing Address - City:SILVIS
Mailing Address - State:IL
Mailing Address - Zip Code:61282
Mailing Address - Country:US
Mailing Address - Phone:309-796-2060
Mailing Address - Fax:309-796-2520
Practice Address - Street 1:1314 10TH ST
Practice Address - Street 2:
Practice Address - City:SILVIS
Practice Address - State:IL
Practice Address - Zip Code:61282
Practice Address - Country:US
Practice Address - Phone:309-796-2060
Practice Address - Fax:309-796-2520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-14
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty