Provider Demographics
NPI:1841480589
Name:CARLE FOUNDATION HOSPITAL
Entity type:Organization
Organization Name:CARLE FOUNDATION HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:RESEARCH ANALYST
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:SCHREIBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-586-5419
Mailing Address - Street 1:PO BOX 718
Mailing Address - Street 2:307 E. OAK
Mailing Address - City:MAHOMET
Mailing Address - State:IL
Mailing Address - Zip Code:61853-0718
Mailing Address - Country:US
Mailing Address - Phone:217-586-5419
Mailing Address - Fax:217-586-5298
Practice Address - Street 1:307 E. OAK ST.
Practice Address - Street 2:
Practice Address - City:MAHOMET
Practice Address - State:IL
Practice Address - Zip Code:61853-9248
Practice Address - Country:US
Practice Address - Phone:217-586-5419
Practice Address - Fax:217-586-5298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-30
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILCCDP00011Medicare PIN