Organization
CARLE HEALTH CARE INCORPORATED
Active
Other names
Carle Physician Group
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN SNYDER (VICE CHAIRMAN)
(217) 383-4604
Entity
Organization
Contact information
Practice address
602 W UNIVERSITY AVE, URBANA, IL 61801-2530
(217) 383-8300
Mailing address
611 W PARK ST, URBANA, IL 61801-2500
(217) 383-6792
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207QA0505X
Adult Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
—
—
208000000X
Pediatrics Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DQ3650
MEDICARE RR
IL
Enumeration date
04/01/2013
Last updated
04/01/2013
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