Healthcare Provider Details

I. General information

NPI: 1699764605
Provider Name (Legal Business Name): CHAMPAIGN URBANA PUBLIC HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 N NEIL ST
CHAMPAIGN IL
61820-3013
US

IV. Provider business mailing address

2346 COUNTY ROAD 3100 N
GIFFORD IL
61847-9708
US

V. Phone/Fax

Practice location:
  • Phone: 217-352-7961
  • Fax: 217-351-5174
Mailing address:
  • Phone: 217-531-4306
  • Fax: 217-351-5174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number StateIL

VIII. Authorized Official

Name: MS. DEBBIE FARMER
Title or Position: ADM ASST.
Credential:
Phone: 217-531-4306