Healthcare Provider Details

I. General information

NPI: 1275213696
Provider Name (Legal Business Name): ONCOLOGY-HEMATOLOGY ASSOCIATES OF CENTRAL ILLINOIS P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2023
Last Update Date: 07/20/2023
Certification Date: 07/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 E GRANT ST
MACOMB IL
61455-3374
US

IV. Provider business mailing address

8940 N WOOD SAGE RD
PEORIA IL
61615-7822
US

V. Phone/Fax

Practice location:
  • Phone: 309-243-3000
  • Fax:
Mailing address:
  • Phone: 309-243-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE PARKER
Title or Position: PHARMACIST
Credential: PHARMACIST
Phone: 309-243-3000