Healthcare Provider Details

I. General information

NPI: 1225194533
Provider Name (Legal Business Name): CARLE SURGICENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 04/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 N VERMILION ST
DANVILLE IL
61832-1735
US

IV. Provider business mailing address

611 W PARK ST
URBANA IL
61801-2500
US

V. Phone/Fax

Practice location:
  • Phone: 217-444-5800
  • Fax: 217-444-5888
Mailing address:
  • Phone: 217-326-2911
  • Fax: 217-344-8047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number007002439
License Number StateIL

VIII. Authorized Official

Name: JAMES C LEONARD
Title or Position: CEO
Credential: MD
Phone: 217-326-4677