FORUM EXTENDED CARE SERVICES OF CENTRAL ILLINOIS (NPI# 1689024036) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1689024036 |
| Entity Type | Organization |
| Organization Name | FORUM EXTENDED CARE SERVICES OF CENTRAL ILLINOIS |
| Other Organization Name | FORUM EXTENDED CARE SERVICES OF CENTRAL ILLINOIS |
| Practice Address |
614 N 6th St Unit 200 Springfield IL 62702-5313 |
| Mailing Address |
4201 W Victoria St Chicago IL 60646-6700 |
| Practice Telephone | 8476738727 |
| Practice Fax Number | 8476736215 |
| Mailing Telephone | 8476738727 |
| Mailing Fax Number | 8476736215 |
| Enumeration Date | 2016-06-16 |
| Last Update Date | 2016-11-10 |
| Authorized Official Name | BRIAN KRAMER (PRESIDENT) |
| Authorized Official Telephone | 8476738727 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 3336I0012X |
Pharmacy Specialization: Institutional Pharmacy |
Suppliers | ||
| N | 333600000X | Pharmacy | Suppliers | ||
| Y | 3336L0003X |
Pharmacy Specialization: Long Term Care Pharmacy |
054020139 | IL | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PK | 2160632 | 01 |
| Other Name | Type Code |
|---|---|
| Forum Extended Care Services of Central Illinois | Doing Business As Name - Organization |
| Street Address |
614 N 6TH ST UNIT 200 |
| City | SPRINGFIELD |
| State | IL |
| Zip Code | 62702-5313 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457866519 | Mohammad Jamal Uddin Ansari | Internal Medicine | 751 N Rutledge St Ste 400, Springfield, IL 62702 | 2017-12-11 |
| 1588105811 | Mickey Graphia | Surgery | 701 N 1st St # D346, Springfield, IL 62702 | 2017-03-20 |
| 1376908913 | Abdul Hannan | Internal Medicine | 315 W Carpenter St # B, Springfield, IL 62702 | 2015-12-28 |
| 1871986414 | Rachel Hoselton | Nurse Practitioner | 400 N 9th St Fl 4, Springfield, IL 62702 | 2015-03-06 |
| 1548697774 | Alyssa Wilson | Behavioral Analyst | 232 Bruns Lane, One Sparcenter Plaza, Springfield, IL 62702 | 2013-10-02 |
| 1174965446 | Amy Wilson | Speech-Language Pathologist | 2120 West Washington Street, Springfield, IL 62702 | 2013-07-26 |
| 1275898116 | Pele Boutrous Dina | Pediatrics | 415 N 9th St # 4w16, Springfield, IL 62702 | 2012-07-06 |
| 1427327733 | Brook D Croke | Genetic Counselor, MS | 400 N. 9th Street, 3rd Floor Clinic B, Springfield, IL 62702 | 2011-12-16 |
| 1629352604 | Renae M Sanchez | Pharmacist | 3216 East Clearlake Ave, Springfield, IL 62702 | 2011-10-07 |
| 1982915302 | William Leland Zelkovich | Radiology | 701 N 1st, Springfield, IL 62702 | 2010-06-30 |
| Find all providers in zip 62702 | ||||
| Taxonomy Code | 3336L0003X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Long Term Care Pharmacy |
| A pharmacy that dispenses medicinal preparations delivered to patients residing within an intermediate or skilled nursing facility, including intermediate care facilities for mentally retarded, hospice, assisted living facilities, group homes, and other forms of congregate living arrangements. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326490376 | Guardian Pharmacy of Missouri LLC | Pharmacy | 2107 E Rockhurst St Ste C, Springfield, MO 65802-6502 | 2016-07-01 |
| 1134218746 | Thrifty Drug Stores Inc | Pharmacy | 18 S Marshall Ave, Springfield, MN 56087-1613 | 2006-10-12 |
| 1346351442 | Managed Healthcare, LLC | Pharmacy | 1947 W Sunset St, Suite 200, Springfield, MO 65807-5903 | 2006-08-31 |
| 1013928654 | Medicine Centre Ltc LLC | Pharmacy | 41 Sullivan St, Springfield, MA 01104 | 2006-08-10 |
| 1033197041 | Christian Health Care Pharmacy LLC | Pharmacy | 1328 E Evergreen St, Springfield, MO 65803-4400 | 2006-01-09 |
| 1598759185 | R & R Family Pharmacy LLC | Pharmacy | 909 Main St, Springfield, CO 81073-1646 | 2005-09-09 |
| 1184288326 | Springfield Pharmacy LLC | Pharmacy | 2547 Main St, Springfield, MA 01107-1900 | 2019-04-23 |
| 1740754159 | Springfield Pharmaceuticals LLC | Pharmacy | 1154 Baltimore Pike, Springfield, PA 19064-2850 | 2019-01-18 |
| 1164576906 | Mcfarland Mental Health Center Pharmacy | Pharmacy | 901 Southwind Dr, Springfield, IL 62703-5125 | 2007-01-22 |
| 1710087085 | Main Street Pharmacy, LLC | Pharmacy | 7440 Spring Village Dr, Springfield, VA 22150-4446 | 2006-09-25 |
| Find all providers in SPRINGFIELD | ||||
| City | SPRINGFIELD |
| Zip Code | 62702 |
Please comment or provide details below to improve the information on FORUM EXTENDED CARE SERVICES OF CENTRAL ILLINOIS.
| 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.