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NPI Code Detail

MEDICARE: CARLE BROMENN MEDICAL CENTER

MEDICARE: CARLE BROMENN MEDICAL CENTER
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
13336C0003XCommunity/Retail Pharmacy054016773IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12123915OTHERPK

General Provider Information

NPI Number : 1962489815
Entity Type Code : Organization
Provider Name (Legal Business Name) : CARLE BROMENN MEDICAL CENTER
Provider Business Mailing Address
First Line : 1304 FRANKLIN AVE
Second Line :
City : NORMAL
State : IL
Zip : 61761-3558
Country : US
Telephone Number : 309-268-5797
Fax Number : 309-268-5524
Provider Business Practice Location Address
First Line : 1304 FRANKLIN AVE
Second Line :
City : NORMAL
State : IL
Zip : 61761-3558
Country : US
Telephone Number : 309-268-5797
Fax Number : 309-268-5524
Authorized Official
Title or Position : VICE PRESIDENT FINANCE
Name : ARON KLEIN
Credential :
Telephone Number : 309-268-2410
Provider Enumeration Date : 12/30/2005
Last Update Date : 11/18/2020

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Directions to “CARLE BROMENN MEDICAL CENTER ” Practice Location

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