Organization
CENTRAL ILLINOIS ASSOCIATES LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHANE FANCHER MD (PRESIDENT)
(217) 464-5839
Entity
Organization
Contact information
Practice address
1800 E LAKE SHORE DR, DECATUR, IL 62521-3810
(217) 464-5839
(217) 464-1671
Mailing address
1800 E LAKE SHORE DR, DECATUR, IL 62521-3810
(217) 464-5839
(217) 464-1671
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
—
—
207LC0200X
Critical Care Medicine (Anesthesiology) Physician
—
—
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
—
—
207LP3000X
Pediatric Anesthesiology Physician
—
—
Other
Enumeration date
12/22/2006
Last updated
01/31/2013
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