SD
SODERSTROM DERMATOLOGY CENTER S C
Adult Day Care
OIG CLEARNPI VERIFIEDMEDICARE ACTIVE
Location
PEORIA, IL
Licensed since
2006
Rate
—
Federal identifiers
NPI registry number1053362343
Agency details
Parent orgSODERSTROM DERMATOLOGY CENTER S C
Medicare activity
StatusActive — enrolled to order & refer
Medicare patients990
RevalidationDue 2024-04-30
Authorized official
NameTINA PEUGH
TitleEXECUTIVE DIRECTOR, SODERSTROM DERM
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