Provider Demographics
NPI:1720799729
Name:THE CARLE FOUNDATION HOSPITAL
Entity Type:Organization
Organization Name:THE CARLE FOUNDATION HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:LEONARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:217-902-5291
Mailing Address - Street 1:3310 FIELDS SOUTH DR
Mailing Address - Street 2:FAPC
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61822-3741
Mailing Address - Country:US
Mailing Address - Phone:217-902-5291
Mailing Address - Fax:217-902-7711
Practice Address - Street 1:1701 CURTIS RD STE 1024
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61822-9678
Practice Address - Country:US
Practice Address - Phone:219-365-5400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE CARLE FOUNDATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-12-09
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies