Healthcare Provider Details

I. General information

NPI: 1699647180
Provider Name (Legal Business Name): FIRSTLINE HEALTHCARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2025
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2043 S NEIL ST
CHAMPAIGN IL
61820-7219
US

IV. Provider business mailing address

2043 S NEIL ST
CHAMPAIGN IL
61820-7219
US

V. Phone/Fax

Practice location:
  • Phone: 217-693-6220
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KURT BLOOMSTRAND
Title or Position: OWNER
Credential: MD
Phone: 217-693-6220