Provider Demographics
NPI:1750306692
Name:CENTRAL ILLINOIS HEMATOLOGY ONCOLOGY CENTER PC
Entity Type:Organization
Organization Name:CENTRAL ILLINOIS HEMATOLOGY ONCOLOGY CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:M SUE
Authorized Official - Middle Name:
Authorized Official - Last Name:COFFEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-292-4492
Mailing Address - Street 1:747 N RUTLEDGE ST
Mailing Address - Street 2:2204
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62702-6700
Mailing Address - Country:US
Mailing Address - Phone:217-525-2500
Mailing Address - Fax:217-525-9374
Practice Address - Street 1:747 N RUTLEDGE ST
Practice Address - Street 2:2204
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62702-6700
Practice Address - Country:US
Practice Address - Phone:217-525-2500
Practice Address - Fax:217-525-9374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CC9240OtherRAILROAD MEDICARE
239274OtherHEALTHLINK INC
CC9240OtherRAILROAD MEDICARE