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Organization
CENTRAL ILLINOIS KIDNEY & DIALYSIS ASSOCIATES, SC
Active
Organization
CENTRAL ILLINOIS KIDNEY & DIALYSIS ASSOCIATES, SC
Active
Other names
Central Illinois Kidney & Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. STEPHANIE ANN SKINNER (OFFICE MANAGER)
(217) 726-0967
Entity
Organization
Contact information
Practice address
3401 CONIFER DR, SPRINGFIELD, IL 62711-8300
(217) 545-8993
(217) 545-8122
Mailing address
3401 CONIFER DR, SPRINGFIELD, IL 62711-8300
(217) 545-8993
(217) 545-8122
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
042005163
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
31664
GHP GROUP PROVIDER NUMBER
—
01
—
8415035
BLUE CROSS BLUE SHIELD NU
—
Enumeration date
07/26/2006
Last updated
02/10/2026
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