ILLINI PEDIATRICS, LLC (NPI# 1346207784) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1346207784 |
| Entity Type | Organization |
| Organization Name | ILLINI PEDIATRICS, LLC |
| Other Organization Name | IDEAL PEDIATRICS |
| Practice Address |
1550 N Main St Ste E Columbia IL 62236 |
| Mailing Address |
1550 N Main St Ste E Columbia IL 62236-1070 |
| Practice Telephone | 6182814325 |
| Practice Fax Number | 6182081313 |
| Mailing Telephone | 6182814325 |
| Mailing Fax Number | 6182081313 |
| Enumeration Date | 2006-04-28 |
| Last Update Date | 2019-03-12 |
| Authorized Official Name | DR. JOSEPH E CANGAS (MANAGING MEMBER) |
| Authorized Official Telephone | 6182814325 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QP2300X |
Clinic/Center Specialization: Primary Care |
036110913 | IL | Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Ideal Pediatrics | Doing Business As Name - Organization |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 109 W Legion Ave, Columbia, IL 622362341 | 6182814325 | 6182081313 |
| 1550 N Main St Ste E, Columbia, IL 62236 | 6182814325 | 6182081313 |
| Street Address |
1550 N MAIN ST STE E |
| City | COLUMBIA |
| State | IL |
| Zip Code | 62236 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295795318 | Joseph Edward Cangas | Pediatrics | 1550 N Main St Ste E, Columbia, IL 62236-1070 | 2006-03-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962937300 | Assoicated Physicians Group Ltd | Nurse Practitioner | 1011 South, Suite 3b, Columbia, IL 62236 | 2017-04-24 |
| 1316284854 | Robert Siekerka | Pharmacist | 1412 N Evergreen Ln, Columbia, IL 62236 | 2013-01-03 |
| 1972874352 | Jennifer Harlin Wilhelm | Veterinarian | 1400 Columbia Center Drive, Bellson Animal Hospital, Columbia, IL 62236 | 2012-01-18 |
| 1912275314 | Synergy Therapeutics, PC | Dentist | 1000 Eleven South, Suite 3f, Columbia, IL 62236 | 2011-12-13 |
| 1134455991 | Julie Williams | Skilled Nursing Facility | 3 Eagle Crest Court, Columbia, IL 62236 | 2009-10-28 |
| 1831311158 | Lifetime Dental Care of Illinois, PC | Dentist | 240 Southwoods Centre Drive, Columbia, IL 62236 | 2007-05-03 |
| 1730301268 | Affordable Dentistry Today, PC | Dentist | 242 Southwoods Centre Drive, Columbia, IL 62236 | 2007-05-03 |
| 1710109616 | Jason Clay King | Chiropractor | 117 West Cedar Street, Columbia, IL 62236 | 2007-05-02 |
| 1184704900 | Mitan Pediatric Therapy Inc | Occupational Therapist | 891 Meadowview Lane, Columbia, IL 62236 | 2006-10-16 |
| 1265528368 | Kathryn Ann Mager | Counselor | 9273 Coach Stop Road, Columbia, IL 62236 | 2006-10-05 |
| Find all providers in zip 62236 | ||||
| Taxonomy Code | 261QP2300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Primary Care |
| Definition to come... |
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| 1740538768 | River of Life Health Center | Clinic/Center | 291 S 4th St, Columbia, PA 17512-1731 | 2012-08-23 |
| 1942504626 | Able Health, LLC | Clinic/Center | 12a Russmar Trl, Columbia, CT 06237-1416 | 2011-01-10 |
| 1881726925 | Jill Murphey,md PC | Clinic/Center | 1701 E Broadway Ste 101, Broadway Plaza IIi, Columbia, MO 65201-8018 | 2007-03-12 |
| 1265525455 | Family Medicine Centers of South Carolina, P.a. | Clinic/Center | 813 Leesburg Rd, Columbia, SC 29209-2127 | 2006-10-02 |
| 1265525463 | Family Medicine Centers of South Carolina, P.a. | Clinic/Center | 300 Rice Meadow Way, Columbia, SC 29229-9466 | 2006-10-02 |
| 1215996046 | Wilson Internal Medicine Pa | Clinic/Center | 4840 Forest Dr, Box 255, Columbia, SC 29206-4810 | 2006-03-21 |
| 1508825340 | Palmetto Family Medicine | Clinic/Center | 109 Barton Creek Court, Columbia, SC 29229-8027 | 2006-03-21 |
| 1942820519 | Stephen Anthony Fuselli | Clinic/Center | 619 N Providence Rd, Columbia, MO 65203-4355 | 2020-04-23 |
| Find all providers in COLUMBIA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.