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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