Healthcare Provider Details

I. General information

NPI: 1801240494
Provider Name (Legal Business Name): CENTRAL ILLINOIS PEDIATRICS LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2016
Last Update Date: 04/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 W TEMPLE AVE STE 203
EFFINGHAM IL
62401-2187
US

IV. Provider business mailing address

900 W TEMPLE AVE STE 203
EFFINGHAM IL
62401-2187
US

V. Phone/Fax

Practice location:
  • Phone: 217-342-5405
  • Fax: 217-342-5564
Mailing address:
  • Phone: 217-342-5405
  • Fax: 217-342-5564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036066126
License Number StateIL

VIII. Authorized Official

Name: DR. WILLIAM L ECKSTEIN
Title or Position: PRESIDENT
Credential: MD
Phone: 217-342-5405