Provider Demographics
NPI:1578724753
Name:MCKINLEY HEALTH CENTER
Entity Type:Organization
Organization Name:MCKINLEY HEALTH CENTER
Other - Org Name:UNIVERSITY OF ILLINOIS CHAMPAIGN/URBANA
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:D
Authorized Official - Last Name:PALINKAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:217-244-5345
Mailing Address - Street 1:1109 S LINCOLN AVE
Mailing Address - Street 2:MC-026
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801-4703
Mailing Address - Country:US
Mailing Address - Phone:217-333-2711
Mailing Address - Fax:217-244-1758
Practice Address - Street 1:1109 S LINCOLN AVE
Practice Address - Street 2:MC-026
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61801-4703
Practice Address - Country:US
Practice Address - Phone:217-333-2711
Practice Address - Fax:217-244-1758
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY OF ILLINOIS CHAMPAIGN/URBANA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-20
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036105311261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1174669212OtherFOR THIRD PARTY
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