Provider Demographics
NPI:1225194533
Name:CARLE SURGICENTER
Entity Type:Organization
Organization Name:CARLE SURGICENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:C
Authorized Official - Last Name:LEONARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:217-326-4677
Mailing Address - Street 1:611 W PARK ST
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801-2500
Mailing Address - Country:US
Mailing Address - Phone:217-326-2911
Mailing Address - Fax:217-344-8047
Practice Address - Street 1:2300 N VERMILION ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832-1735
Practice Address - Country:US
Practice Address - Phone:217-444-5800
Practice Address - Fax:217-444-5888
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARLE FOUNDATION HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-29
Last Update Date:2012-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL007002439261QA1903X
282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
075430OtherHAMP PROVIDER ID
203OtherBLUE CROSS PROVIDER ID
7216OtherPERSONALCARE PROVIDER ID
113326OtherHEALTHLINK PROVIDER ID
113326OtherHEALTHLINK PROVIDER ID
113326OtherHEALTHLINK PROVIDER ID