Provider Demographics
NPI:1285378091
Name:ONCOLOGY HEMATOLOGY ASSOCIATES OF CENTRAL IL, PC
Entity type:Organization
Organization Name:ONCOLOGY HEMATOLOGY ASSOCIATES OF CENTRAL IL, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PAYER RELATIONS
Authorized Official - Prefix:
Authorized Official - First Name:JANELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-243-3501
Mailing Address - Street 1:8940 N WOOD SAGE RD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-7822
Mailing Address - Country:US
Mailing Address - Phone:309-243-3404
Mailing Address - Fax:309-243-3032
Practice Address - Street 1:8940 N WOOD SAGE RD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-7822
Practice Address - Country:US
Practice Address - Phone:309-243-3404
Practice Address - Fax:309-243-3032
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ONCOLOGY HEMATOLOGY ASSOCIATES OF CENTRAL IL, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-04-27
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL054016528OtherSTATE LICENSE