Healthcare Provider Details

I. General information

NPI: 1265605117
Provider Name (Legal Business Name): CARLE FOUNDATION HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2008
Last Update Date: 02/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 WEST UNIVERSITY SUITE 1201
URBANA IL
61801
US

IV. Provider business mailing address

611 W PARK
URBANA IL
61801
US

V. Phone/Fax

Practice location:
  • Phone: 217-326-3168
  • Fax: 217-367-2827
Mailing address:
  • Phone: 217-383-3311
  • Fax: 217-367-2827

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: JULIANNA S SELLETT
Title or Position: DIRECTOR
Credential: RN
Phone: 217-383-3488