Provider Demographics
NPI:1609906999
Name:CARLE CLINIC ASSOCIATION
Entity Type:Organization
Organization Name:CARLE CLINIC ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HOSPITALIST
Authorized Official - Prefix:
Authorized Official - First Name:ZUHEIR
Authorized Official - Middle Name:
Authorized Official - Last Name:KASSABO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:217-355-7951
Mailing Address - Street 1:701 KREBS DR
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61822
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:701 KREBS DR
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61822
Practice Address - Country:US
Practice Address - Phone:217-355-7951
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-115508207R00000X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes282N00000XHospitalsGeneral Acute Care Hospital
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036115508Medicaid
ILCA2264OtherRR GROUP #
833120OtherMEDICARE GROUP #
ILP00729199OtherRR MEDICARE INDIVIDUAL #
ILCA2264OtherRR GROUP #