NPIMap

Organization Active NPI

Central Illinois Oral & Maxillofacial Surgery

  • Oral and Maxillofacial Surgery (Dentist)
  • Effingham, IL
National Provider Identifier
1679733976
Registry record updated Nov 12, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
Legal business name
CENTRAL ILLINOIS ORAL & MAXILLOFACIAL SURGERY
Practice address
1200 Network Centre Dr Ste a
Effingham, IL 62401-4637
Phone
(217) 540-5100
Fax
(877) 635-3298
NPI assigned
Jun 11, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 12, 2008

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

Authorized official

Name
Amy Kroeger
Title
Insurance Coordinator
Phone
(217) 540-5100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist)Group: 193200000X MULTI-SPECIALTY GROUP 1223S0112X Primary

Addresses

Primary practice location

1200 Network Centre Dr Ste a
Effingham, IL 62401-4637

Mailing address

1200 Network Centre Dr Ste a
Effingham, IL 62401-4637
Phone (217) 540-5100

National Provider Directory

National Provider Directory
Tax ID family
Central Illinois Oral Maxillofacial Surgery4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1200 Network Centre Dr
Ste A
Effingham, IL 62401
Phone (217) 540-5348

Ownership & related parties

Subparts reporting this organization as parent 2

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

NPI Registry JSON

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

{
    "created_epoch": "1213142400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1226448000000",
    "number": "1679733976",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 NETWORK CENTRE DR STE A",
            "city": "EFFINGHAM",
            "state": "IL",
            "postal_code": "624014637",
            "telephone_number": "217-540-5100",
            "fax_number": "877-635-3298"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 NETWORK CENTRE DR STE A",
            "city": "EFFINGHAM",
            "state": "IL",
            "postal_code": "624014637",
            "telephone_number": "217-540-5100",
            "fax_number": "877-635-3298"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL ILLINOIS ORAL & MAXILLOFACIAL SURGERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-11",
        "last_updated": "2008-11-12",
        "status": "A",
        "authorized_official_last_name": "KROEGER",
        "authorized_official_first_name": "AMY",
        "authorized_official_title_or_position": "INSURANCE COORDINATOR",
        "authorized_official_telephone_number": "217-540-5100"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Effingham, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 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.