Provider Demographics
NPI:1467456996
Name:CENTRAL ILLINOIS PEDIATRICS, LTD
Entity Type:Organization
Organization Name:CENTRAL ILLINOIS PEDIATRICS, LTD
Other - Org Name:DR. WILLIAM ECKSTEIN
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:L
Authorized Official - Last Name:ECKSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:217-342-5405
Mailing Address - Street 1:900 W TEMPLE AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:EFFINGHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62401-2187
Mailing Address - Country:US
Mailing Address - Phone:217-342-5405
Mailing Address - Fax:217-342-5564
Practice Address - Street 1:900 W TEMPLE AVE STE 203
Practice Address - Street 2:
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401-2187
Practice Address - Country:US
Practice Address - Phone:217-342-5405
Practice Address - Fax:217-342-5564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-13
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036066126261QF0400X, 261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL015857OtherHEALTH ALLIANCE INS
IL036066126Medicaid
IL167190OtherHEALTHLINK INS.
IL2507249OtherBLUE CROSS
IL2507249OtherBLUE CROSS
ILF71833Medicare UPIN