1053467050 NPI number — CARLE FOUNDATION HOSPITAL

Table of content: (NPI 1053467050)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053467050 NPI number — CARLE FOUNDATION HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARLE FOUNDATION HOSPITAL
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CARLE RX EXPRESS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053467050
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/10/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
611 W PARK ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
URBANA
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61801-2500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
217-326-2906
Provider Business Mailing Address Fax Number:
217-326-2996

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
311 W FAIRCHILD ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
DANVILLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61832-3876
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-431-7975
Provider Business Practice Location Address Fax Number:
217-431-7979
Provider Enumeration Date:
01/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
TONKINSON
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
E
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
217-383-3441

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  054012046 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1448679 . This is a "NABP ID NUMBER" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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