MEDICARE: CENTRAL ILLINOIS PEDIATRICS LTD

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
1	208000000X	Pediatrics Physician	036066126	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	015857	OTHER	IL	HEALTH ALLIANCE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	167190	OTHER	IL	HEALTHLINK
4	2507249	OTHER	IL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1801240494
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRAL ILLINOIS PEDIATRICS LTD

Provider Business Mailing Address
First Line	:	900 W TEMPLE AVE STE 203
Second Line	:
City	:	EFFINGHAM
State	:	IL
Zip	:	62401-2187
Country	:	US
Telephone Number	:	217-342-5405
Fax Number	:	217-342-5564

Provider Business Practice Location Address
First Line	:	900 W TEMPLE AVE STE 203
Second Line	:
City	:	EFFINGHAM
State	:	IL
Zip	:	62401-2187
Country	:	US
Telephone Number	:	217-342-5405
Fax Number	:	217-342-5564

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. WILLIAM L ECKSTEIN
Credential	:	MD
Telephone Number	:	217-342-5405

Provider Enumeration Date	:	04/20/2016
Last Update Date	:	04/20/2016

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Directions to “CENTRAL ILLINOIS PEDIATRICS LTD ” Practice Location

Language	Start Address	Practice Location

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