Provider Demographics
NPI:1285034157
Name:CHAMPAIGN-URBANA HEALTHCARE LLC
Entity Type:Organization
Organization Name:CHAMPAIGN-URBANA HEALTHCARE LLC
Other - Org Name:CAMPUSTOWN URGENT CARE LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-344-9909
Mailing Address - Street 1:631 E GREEN ST
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61820-5701
Mailing Address - Country:US
Mailing Address - Phone:217-344-9909
Mailing Address - Fax:217-903-3941
Practice Address - Street 1:631 E GREEN ST
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-5701
Practice Address - Country:US
Practice Address - Phone:217-344-9909
Practice Address - Fax:217-903-3941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-28
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL03606913261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care