NPIMap

Organization Active NPI

Western Illinois Cancer Treatment Center

  • Radiation Therapy Radiologic Technologist
  • Galesburg, IL
National Provider Identifier
1417985011
Registry record updated Apr 30, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiation Therapy Radiologic TechnologistTaxonomy code 2471R0002X
License
036077270 Issued in IL
Legal business name
WESTERN ILLINOIS CANCER TREATMENT CENTER
Practice address
450 Mayo Dr
Galesburg, IL 61401-1211
Phone
(309) 344-2831
Fax
(309) 344-2014
NPI assigned
Jun 30, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 30, 2008

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

Authorized official

Name
Dr. Warren M Wilkins, M.D.NPI 1255429494
Title
Medical Director
Phone
(309) 344-2831

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Radiation Therapy Radiologic TechnologistGroup: 193400000X SINGLE SPECIALTY GROUP 2471R0002X 036077270 IL Primary

Addresses

Primary practice location

450 Mayo Dr
Galesburg, IL 61401-1211

Mailing address

450 Mayo Dr
Galesburg, IL 61401-1211
Phone (309) 344-2831

Other identifiers 4

IdentifierTypeStateIssuer
007799OtherHEALTH ALLIANCE
014885OtherILHEALTH ALLIANCE INS.
04815059OtherBLUE CROSS BLUE SHIELD
CM5868OtherILRAILROAD MEDICARE

Other names 1

  • InterCommunity Cancer Center of Western Illinois Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1151625600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1209513600000",
    "number": "1417985011",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "450 MAYO DR",
            "city": "GALESBURG",
            "state": "IL",
            "postal_code": "614011211",
            "telephone_number": "309-344-2831",
            "fax_number": "309-344-2014"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "450 MAYO DR",
            "city": "GALESBURG",
            "state": "IL",
            "postal_code": "614011211",
            "telephone_number": "309-344-2831",
            "fax_number": "309-344-2014"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WESTERN ILLINOIS CANCER TREATMENT CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-30",
        "last_updated": "2008-04-30",
        "status": "A",
        "authorized_official_last_name": "WILKINS",
        "authorized_official_first_name": "WARREN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "309-344-2831",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2471R0002X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiologic Technologist, Radiation Therapy",
            "state": "IL",
            "license": "036077270",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH ALLIANCE",
            "identifier": "007799",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH ALLIANCE INS.",
            "identifier": "014885",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "04815059",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CM5868",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "InterCommunity Cancer Center of Western Illinois",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Galesburg, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2008; 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.