1215463971 NPI number — MERCY E EIGBIKE MD

Table of content: MERCY E EIGBIKE MD (NPI 1215463971)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215463971 NPI number — MERCY E EIGBIKE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EIGBIKE
Provider First Name:
MERCY
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1215463971
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/01/2020
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:
UICOM AT URBANA-CHAMPAIGN CARLE FORUM-LOWERLEVEL,MC-474
Provider Business Mailing Address City Name:
URBANA
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61801-2529
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
217-383-4615
Provider Business Mailing Address Fax Number:
217-383-3121

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1802 S MATTIS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHAMPAIGN
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61821-5923
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-365-2855
Provider Business Practice Location Address Fax Number:
217-365-2856
Provider Enumeration Date:
05/02/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  125.070155 , 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)





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