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Organization
WESTERN ILLINOIS CANCER TREATMENT CENTER
Active
Organization
WESTERN ILLINOIS CANCER TREATMENT CENTER
Active
Other names
InterCommunity Cancer Center of Western Illinois
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WARREN M WILKINS M.D. (MEDICAL DIRECTOR)
(309) 344-2831
Entity
Organization
Contact information
Practice address
450 MAYO DR, GALESBURG, IL 61401-1211
(309) 344-2831
(309) 344-2014
Mailing address
450 MAYO DR, GALESBURG, IL 61401-1211
(309) 344-2831
(309) 344-2014
Taxonomy
Speciality
Code
Description
License number
State
2471R0002X
Radiation Therapy Radiologic Technologist
Primary
036077270
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
007799
HEALTH ALLIANCE
—
01
—
014885
HEALTH ALLIANCE INS.
IL
01
—
04815059
BLUE CROSS BLUE SHIELD
—
01
—
CM5868
RAILROAD MEDICARE
IL
Enumeration date
06/30/2006
Last updated
04/30/2008
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