Healthcare Provider Details

I. General information

NPI: 1457347668
Provider Name (Legal Business Name): THE CARLE FOUNDATION HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2005
Last Update Date: 02/12/2020
Certification Date: 02/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 N BROADWAY AVE STE 100
URBANA IL
61801-2747
US

IV. Provider business mailing address

611 W PARK
URBANA IL
61801
US

V. Phone/Fax

Practice location:
  • Phone: 217-383-3099
  • Fax:
Mailing address:
  • Phone: 217-383-3311
  • Fax: 217-355-8133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

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