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CENTRAL ILLINOIS PEDIATRIC ASSOCIATES LLC NPI 1174706816


NPI Information

NPI: 1174706816
Provider Name: CENTRAL ILLINOIS PEDIATRIC ASSOCIATES LLC
Classification: Clinic/Center - 261QP2300X
Entity Type: Organization

Specialization: Primary Care

CLIA Number: 14D0432270

Address:
2427 MALONEY DR
BLOOMINGTON, IL
ZIP 61704
Phone: (309) 663-1011
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CENTRAL ILLINOIS PEDIATRIC ASSOCIATES LLC is a primary care clinic center in Bloomington, IL. CENTRAL ILLINOIS PEDIATRIC ASSOCIATES LLC NPI is 1174706816. The provider is registered as an organization entity type.

The provider's business location address is:

2427 MALONEY DR
BLOOMINGTON, IL
ZIP 61704-750
Phone: (309) 663-1011

The provider's authorized official is Sanjay Saxena .
The authorized official title is Owner and has the following contact phone number (309) 663-1011.

The CLIA number assigned to this NPI record is 14D0432270 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 12/17/2007 and was last updated on 12/17/2007.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1261QP2300XClinic/CenterPrimary CareYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

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