Provider Demographics
NPI:1558460584
Name:PLANNED PARENTHOOD OF EAST CENTRAL ILLINOIS
Entity Type:Organization
Organization Name:PLANNED PARENTHOOD OF EAST CENTRAL ILLINOIS
Other - Org Name:PPECI
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:KARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-359-4768
Mailing Address - Street 1:302 E STOUGHTON ST
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61820-5414
Mailing Address - Country:US
Mailing Address - Phone:217-359-4768
Mailing Address - Fax:217-359-2683
Practice Address - Street 1:302 E STOUGHTON ST
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-5414
Practice Address - Country:US
Practice Address - Phone:217-359-4768
Practice Address - Fax:217-359-2683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL7001837261QA0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL=========001Medicaid