Organization
SQUARE 1 HEALTHCARE COMPANY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ARUN ABRAHAM MD (PRESIDENT)
(217) 953-0352
Entity
Organization
Contact information
Practice address
511 N NEIL ST, CHAMPAIGN, IL 61820-3688
(815) 408-0833
Mailing address
401 CLIPPER RD, SPRINGFIELD, IL 62711-8010
(217) 953-0352
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1255578316
—
IL
05
—
1841767084
—
IL
Enumeration date
09/27/2023
Last updated
09/27/2023
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