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General NPI Number Information
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NPI Number | 1649588443
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Entity Type | Organization
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Legal Business Name | CARLE FOUNDATION HOSPITAL
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Dates
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Enumeration Date | 09/15/2010
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Last Update Date | 09/15/2010
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Provider Practice Location Address
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Address Line | 602 W. UNIVERSITY AVE.
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City | URBANA
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State | IL
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Zip | 61801
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Country | US
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Telephone | 217-383-3170
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Fax | 217-326-1300
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Provider Business Mailing Address
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Address Line | 611 W UNIVERSITY AVE
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City | URBANA
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State | IL
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Zip | 61801-2530
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Country | US
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Telephone | 217-383-3302
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Fax | 217-326-1300
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Authorized Official
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Title or Position | RESIDENCY COORDINATOR
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Name | MS. JAIME BLAKELY
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Credential |
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Telephone | 217-383-3302
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 125058954
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License Number State | IL
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