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General NPI Number Information
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NPI Number | 1467231589
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Entity Type | Organization
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Legal Business Name | SQUARE 1 HEALTHCARE COMPANY
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Dates
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Enumeration Date | 09/27/2023
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Last Update Date | 09/27/2023
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Provider Practice Location Address
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Address Line | 511 N NEIL ST
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City | CHAMPAIGN
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State | IL
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Zip | 61820-3688
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Country | US
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Telephone | 815-408-0833
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Fax |
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Provider Business Mailing Address
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Address Line | 401 CLIPPER RD
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City | SPRINGFIELD
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State | IL
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Zip | 62711-8010
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Country | US
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Telephone | 217-953-0352
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ARUN ABRAHAM
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Credential | MD
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Telephone | 217-953-0352
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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