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General NPI Number Information
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NPI Number | 1093835886
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Entity Type | Organization
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Legal Business Name | CARLE CLINIC ASSOCIATION, PC
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Dates
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Enumeration Date | 03/29/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 2300 N VERMILION ST
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City | DANVILLE
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State | IL
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Zip | 61832-1735
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Country | US
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Telephone | 217-431-7600
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Fax |
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Provider Business Mailing Address
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Address Line | 2300 N VERMILION ST
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City | DANVILLE
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State | IL
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Zip | 61832-1735
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Country | US
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Telephone | 217-431-7600
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Fax |
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Authorized Official
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Title or Position | SENIOR VICE PRESIDENT
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Name | KIRK MOBERG
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Credential | M.D., PH.D.
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Telephone | 217-337-4105
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State | IL
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Taxonomy #5
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State | IL
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