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General NPI Number Information
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NPI Number | 1801486550
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Entity Type | Organization
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Legal Business Name | CHRISTIE CLINIC, LLC
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Dates
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Enumeration Date | 01/26/2021
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Last Update Date | 01/26/2021
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Provider Practice Location Address
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Address Line | 300 N MAIN ST
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City | TUSCOLA
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State | IL
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Zip | 61953-1406
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Country | US
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Telephone | 217-253-9258
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Fax |
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Provider Business Mailing Address
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Address Line | 101 W UNIVERSITY AVE
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City | CHAMPAIGN
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State | IL
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Zip | 61820-3981
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Country | US
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Telephone | 217-366-8107
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Fax |
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Authorized Official
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Title or Position | CMO
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Name | WILLIAM PIERCE
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Credential | DPM
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Telephone | 217-366-8107
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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