1982602330 NPI number — CHAMPAIGN COUNTY

Table of content: (NPI 1982602330)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982602330 NPI number — CHAMPAIGN COUNTY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHAMPAIGN COUNTY
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:
Provider Other Organization Name Type Code:
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:
1982602330
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/04/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 SOUTH ART BARTELL ROAD
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:
61802
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
217-384-3784
Provider Business Mailing Address Fax Number:
217-337-0120

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 SOUTH ART BARTELL ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
URBANA
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-384-3874
Provider Business Practice Location Address Fax Number:
217-337-0120
Provider Enumeration Date:
07/11/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
NOFFKE
Authorized Official First Name:
KAREN
Authorized Official Middle Name:
L
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
217-693-5015

Provider Taxonomy Codes

  • Taxonomy code: 313M00000X , with the licence number:  0001636 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 314000000X , with the licence number: 0001636 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332BN1400X , with the licence number: 001636 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BP3500X , with the licence number: 001636 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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