Healthcare Provider Details

I. General information

NPI: 1356874093
Provider Name (Legal Business Name): CANCER CARE SPECIALISTS OF CENTRAL ILLINOIS, S.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2017
Last Update Date: 09/02/2025
Certification Date: 01/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 W MCKINLEY AVE SUITE 6
DECATUR IL
62526-5858
US

IV. Provider business mailing address

210 W MCKINLEY AVE SUITE 6
DECATUR IL
62526-5858
US

V. Phone/Fax

Practice location:
  • Phone: 217-329-3239
  • Fax: 217-876-9829
Mailing address:
  • Phone: 217-329-3239
  • Fax: 217-876-9829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: PERRY GUAGLIANONE
Title or Position: DIRECTOR
Credential: MD
Phone: 217-876-6600