Provider Demographics
NPI:1699764605
Name:CHAMPAIGN URBANA PUBLIC HEALTH
Entity type:Organization
Organization Name:CHAMPAIGN URBANA PUBLIC HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADM ASST.
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FARMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-531-4306
Mailing Address - Street 1:2346 COUNTY ROAD 3100 N
Mailing Address - Street 2:
Mailing Address - City:GIFFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61847-9708
Mailing Address - Country:US
Mailing Address - Phone:217-531-4306
Mailing Address - Fax:217-351-5174
Practice Address - Street 1:710 N NEIL ST
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-3013
Practice Address - Country:US
Practice Address - Phone:217-352-7961
Practice Address - Fax:217-351-5174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========-001Medicaid