Healthcare Provider Details

I. General information

NPI: 1053378349
Provider Name (Legal Business Name): THE CARLE FOUNDATION HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 03/02/2020
Certification Date: 03/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 LERNA RD S STE 101
MATTOON IL
61938-9301
US

IV. Provider business mailing address

611 W PARK
URBANA IL
61801
US

V. Phone/Fax

Practice location:
  • Phone: 217-258-7600
  • Fax: 217-258-3878
Mailing address:
  • Phone: 217-383-3311
  • Fax: 217-235-6460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: JAMES LEONARD
Title or Position: CEO
Credential: MD
Phone: 217-383-3220