Basic Information
| Provider Information | |||||||||
| NPI: | 1366400608 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALBINSON | ||||||||
| FirstName: | CHARLOTTE | ||||||||
| MiddleName: | HOPE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 725 SCHOOL ST STE A | ||||||||
| Address2: | |||||||||
| City: | MORRIS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604501207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8159422932 | ||||||||
| FaxNumber: | 8159414363 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 GORE RD | ||||||||
| Address2: | |||||||||
| City: | MORRIS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604509466 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8153648919 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2006 | ||||||||
| LastUpdateDate: | 01/23/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 036.112887 | IL | N | Allopathic & Osteopathic Physicians | Family Medicine | 207P00000X | 036112887 | IL | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 036112887 | 05 | IL | MEDICAID |