Healthcare Provider Details

I. General information

NPI: 1053932426
Provider Name (Legal Business Name): THE CARLE FOUNDATION HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2020
Last Update Date: 03/07/2025
Certification Date: 03/07/2025
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

611 W PARK ST
URBANA IL
61801-2529
US

V. Phone/Fax

Practice location:
  • Phone: 217-383-8700
  • Fax: 217-355-6789
Mailing address:
  • Phone: 217-383-3311
  • Fax: 217-355-8133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

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