WESTERN ILLINOIS CANCER TREATMENT CENTER (NPI# 1417985011) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417985011 |
| Entity Type | Organization |
| Organization Name | WESTERN ILLINOIS CANCER TREATMENT CENTER |
| Other Organization Name | INTERCOMMUNITY CANCER CENTER OF WESTERN ILLINOIS |
| Practice Address |
450 Mayo Dr Galesburg IL 61401-1211 |
| Practice Telephone | 3093442831 |
| Practice Fax Number | 3093442014 |
| Mailing Telephone | 3093442831 |
| Mailing Fax Number | 3093442014 |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2008-04-30 |
| Authorized Official Name | DR. WARREN M WILKINS (MEDICAL DIRECTOR) |
| Authorized Official Telephone | 3093442831 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2471R0002X |
Radiologic Technologist Specialization: Radiation Therapy |
036077270 | IL | Technologists, Technicians & Other Technical Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| HEALTH ALLIANCE | 007799 | 01 | |
| IL | HEALTH ALLIANCE INS. | 014885 | 01 |
| BLUE CROSS BLUE SHIELD | 04815059 | 01 | |
| IL | RAILROAD MEDICARE | CM5868 | 01 |
| Other Name | Type Code |
|---|---|
| InterCommunity Cancer Center of Western Illinois | Doing Business As Name - Organization |
| Street Address |
450 MAYO DR |
| City | GALESBURG |
| State | IL |
| Zip Code | 61401-1211 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255429494 | Warren Matthew Wilkins | Specialist | 450 Mayo Dr, Galesburg, IL 61401-1211 | 2006-10-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679174973 | Jeff Engwall | Pharmacist | 359 Knox Square Drive, Galesburg, IL 61401 | 2020-11-03 |
| 1861962441 | Becky Cameron | Counselor | 2323 Windish Dr., Galesburg, IL 61401 | 2018-11-27 |
| 1295245496 | Aaron Thomas Wachtel | Dentist | 1172 Monroe Street, Galesburg, IL 61401 | 2017-10-03 |
| 1588182224 | Alicia Warren | Speech-Language Pathologist | 932 Harrison St., Galesburg, IL 61401 | 2017-09-01 |
| 1770986770 | Virginia G Kasser | Psychologist | 575 N Kellogg, Galesburg, IL 61401 | 2014-10-03 |
| 1063814309 | Lakshmi Kalyani Gudavalli | Physical Therapist | 275 E Carl Sandburg Drive, Marigold Rehabilitation, Galesburg, IL 61401 | 2014-09-18 |
| 1821350489 | James Eugene Tiller | Psychologist | 2101 Windish Drive, Galesburg, IL 61401 | 2012-06-11 |
| 1720285836 | Donald J. Regnier | Hearing Instrument Specialist | 4l Plaza, Suite 57, Galesburg, IL 61401 | 2007-07-02 |
| 1306066535 | Arnold John Minor | Dentist | 69 N Chambers St, Galesburg, IL 61401 | 2007-04-30 |
| 1114140373 | Community Residential Centers Inc | Intermediate Care Facility, Mentally Retarded | 239 S Cherry Street, Galesburg, IL 61401 | 2007-04-10 |
| Find all providers in zip 61401 | ||||
| Taxonomy Code | 2471R0002X |
| Grouping | Technologists, Technicians & Other Technical Service Providers |
| Classification | Radiologic Technologist |
| Specialization | Radiation Therapy |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598135063 | Joshua Mccann | Radiologic Technologist | 386 Rohlfing Rd, Campbell Hill, IL 62916-2410 | 2015-09-28 |
| 1386644995 | Northern Illinois Cancer Treatment Center | Radiologic Technologist | 327 Il Route 2, Dixon, IL 61021-9118 | 2005-07-26 |
| 1679196125 | Jarrod Alan Walters | Radiologic Technologist | 4455 Weaver Pkwy, Warrenville, IL 60555-3269 | 2020-05-19 |
Please comment or provide details below to improve the information on WESTERN ILLINOIS CANCER TREATMENT CENTER.
| 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.