Healthcare Provider Details

I. General information

NPI: 1821582131
Provider Name (Legal Business Name): THE CARLE FOUNDATION HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2018
Last Update Date: 06/06/2022
Certification Date: 06/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 N BROADWAY AVE STE 100
URBANA IL
61801-2748
US

IV. Provider business mailing address

221 N BROADWAY AVE STE 100
URBANA IL
61801-2748
US

V. Phone/Fax

Practice location:
  • Phone: 217-383-3099
  • Fax: 217-355-6789
Mailing address:
  • Phone: 217-383-3099
  • Fax: 217-355-6789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JAMES LEONARD
Title or Position: CEO
Credential: MD
Phone: 217-383-3311