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NPI Code Detail

MEDICARE: CARLE CLINIC ASSOCIATION, PC

MEDICARE: CARLE CLINIC ASSOCIATION, PC
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
1332B00000XDurable Medical Equipment & Medical SuppliesIL

General Provider Information

NPI Number : 1649466186
Entity Type Code : Organization
Provider Name (Legal Business Name) : CARLE CLINIC ASSOCIATION, PC
Provider Business Mailing Address
First Line : 610 N LINCOLN AVE
Second Line :
City : URBANA
State : IL
Zip : 61801-2432
Country : US
Telephone Number : 217-383-6555
Fax Number :
Provider Business Practice Location Address
First Line : 610 N LINCOLN AVE
Second Line :
City : URBANA
State : IL
Zip : 61801-2432
Country : US
Telephone Number : 217-383-6555
Fax Number :
Authorized Official
Title or Position : SENIOR VICE PRESIDENT
Name : KIRK MOBERG
Credential : M.D, PH.D.
Telephone Number : 217-337-4105
Provider Enumeration Date : 09/19/2007
Last Update Date : 09/19/2007

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