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NPI Code Detail

MEDICARE: CENTRAL ILLINOIS KIDNEY & DIALYSIS ASSOCIATES, SC

MEDICARE: CENTRAL ILLINOIS KIDNEY & DIALYSIS ASSOCIATES, SC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RN0300XNephrology Physician042005163IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
131664OTHERGHP GROUP PROVIDER NUMBER
28415035OTHERBLUE CROSS BLUE SHIELD NU

General Provider Information

NPI Number : 1598788994
Entity Type Code : Organization
Provider Name (Legal Business Name) : CENTRAL ILLINOIS KIDNEY & DIALYSIS ASSOCIATES, SC
Provider Business Mailing Address
First Line : 3401 CONIFER DR
Second Line :
City : SPRINGFIELD
State : IL
Zip : 62711-8300
Country : US
Telephone Number : 217-545-8993
Fax Number : 217-545-8122
Provider Business Practice Location Address
First Line : 3401 CONIFER DR
Second Line :
City : SPRINGFIELD
State : IL
Zip : 62711-8300
Country : US
Telephone Number : 217-545-8993
Fax Number : 217-545-8122
Authorized Official
Title or Position : OFFICE MANAGER
Name : MRS. STEPHANIE ANN SKINNER
Credential :
Telephone Number : 217-726-0967
Provider Enumeration Date : 07/26/2006
Last Update Date : 02/10/2026

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Directions to “CENTRAL ILLINOIS KIDNEY & DIALYSIS ASSOCIATES, SC ” Practice Location

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