Basic Information
| Provider Information | |||||||||
| NPI: | 1053932426 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | THE CARLE FOUNDATION HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 611 W PARK ST | ||||||||
| Address2: | |||||||||
| City: | URBANA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 618012529 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2173833311 | ||||||||
| FaxNumber: | 2173558133 | ||||||||
| Practice Location | |||||||||
| Address1: | 221 N BROADWAY AVE STE 100 | ||||||||
| Address2: | |||||||||
| City: | URBANA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 618012748 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2173838700 | ||||||||
| FaxNumber: | 2173556789 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2020 | ||||||||
| LastUpdateDate: | 04/27/2020 | ||||||||
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| AuthorizedOfficialLastName: | LEONARD | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 2173833220 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| NPICertificationDate: | 04/27/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3336S0011X | Y | Suppliers | Pharmacy | Specialty Pharmacy |
No ID Information.