Healthcare Provider Details

I. General information

NPI: 1053467050
Provider Name (Legal Business Name): CARLE FOUNDATION HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 02/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 W FAIRCHILD ST SUITE B
DANVILLE IL
61832-3876
US

IV. Provider business mailing address

611 W PARK ST
URBANA IL
61801-2500
US

V. Phone/Fax

Practice location:
  • Phone: 217-431-7975
  • Fax: 217-431-7979
Mailing address:
  • Phone: 217-326-2906
  • Fax: 217-326-2996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number054012046
License Number StateIL

VIII. Authorized Official

Name: MR. ROBERT E TONKINSON JR.
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 217-383-3441