Provider Demographics
NPI:1053378349
Name:THE CARLE FOUNDATION HOSPITAL
Entity type:Organization
Organization Name:THE CARLE FOUNDATION HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:LEONARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:217-383-3220
Mailing Address - Street 1:611 W PARK
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801
Mailing Address - Country:US
Mailing Address - Phone:217-383-3311
Mailing Address - Fax:217-235-6460
Practice Address - Street 1:200 LERNA RD S STE 101
Practice Address - Street 2:
Practice Address - City:MATTOON
Practice Address - State:IL
Practice Address - Zip Code:61938-9301
Practice Address - Country:US
Practice Address - Phone:217-258-7600
Practice Address - Fax:217-258-3878
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARLE FOUNDATION HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-28
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========008Medicaid
IL0409020002Medicare ID - Type Unspecified