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Organization

CARLE CLINIC ASSOCIATION, PC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
KIRK MOBERG M.D., PH.D. (SENIOR VICE PRESIDENT)
(217) 337-4105
Entity
Organization

Contact information

Practice address
602 W UNIVERSITY AVE, URBANA, IL 61801-2530
(217) 383-3311
Mailing address
602 W UNIVERSITY AVE, URBANA, IL 61801-2530
(217) 383-3311

Taxonomy

Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
060004307
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0533210001
DMERC
IL
Enumeration date
02/20/2007
Last updated
06/18/2008
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