Carle Clinic Association, PC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

060004307 Issued in IL

Legal business name

CARLE CLINIC ASSOCIATION, PC

Practice address

1802 S Mattis Ave
Champaign, IL 61821-5923

Phone

(217) 326-1220

NPI assigned

Mar 8, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kirk Moberg, M.D., PH.D.

Title

Senior Vice President

Phone

(217) 383-3311

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1293667200000",
    "number": "1003947557",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1802 S MATTIS AVE",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618215923",
            "telephone_number": "217-326-1220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1802 S MATTIS AVE",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618215923",
            "telephone_number": "217-326-1220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARLE CLINIC ASSOCIATION, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-08",
        "last_updated": "2010-12-30",
        "status": "A",
        "authorized_official_last_name": "MOBERG",
        "authorized_official_first_name": "KIRK",
        "authorized_official_title_or_position": "SENIOR VICE PRESIDENT",
        "authorized_official_telephone_number": "217-383-3311",
        "authorized_official_credential": "M.D., PH.D."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "IL",
            "license": "060004307",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Karen Caraway
• Araceli Carbajal, LSW
• Care Planning Institute
• Amanda Carey
• Carle Clinic Association
• Carle Clinic Association, PC
• Carle Clinic Association, PC
• Carle Clinic Association, PC
• Carle Foundation Hospital (Carle RX Express)
• Carle Foundation Hospital (Carle RX Express)

• Durable Medical Equipment & Medical Supplies in Champaign, IL
• Providers in Champaign, IL by specialty
• Durable Medical Equipment & Medical Supplies in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.