Healthcare Provider Details

I. General information

NPI: 1336464957
Provider Name (Legal Business Name): CARLE HEALTH CARE INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2010
Last Update Date: 12/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 E SOUTHLINE RD
TUSCOLA IL
61953-2014
US

IV. Provider business mailing address

301 E SOUTHLINE RD
TUSCOLA IL
61953-2014
US

V. Phone/Fax

Practice location:
  • Phone: 217-253-5231
  • Fax:
Mailing address:
  • Phone: 217-253-5231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN SNYDER
Title or Position: VICE PRESIDENT
Credential:
Phone: 217-326-8300