| Shawnee Health Care, Carbondale Dental | |
|
402 S. Lewis Lane Carbondale IL 62901 | |
| (618) 519-9901 | |
| Not Available |
| Full Name | Shawnee Health Care, Carbondale Dental |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 402 S. Lewis Lane, Carbondale, Illinois |
| Authorized Official Name and Position | Christina Carney (CEO) |
| Authorized Official Contact | 6189569521 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Shawnee Health Care, Carbondale Dental 109 California St Po Box 577 Carterville IL 62918-1923 Ph: (618) 985-8221 | Shawnee Health Care, Carbondale Dental 402 S. Lewis Lane Carbondale IL 62901 Ph: (618) 519-9901 |
| NPI Number | 1174859870 |
|---|---|
| Provider Enumeration Date | 10/30/2009 |
| Last Update Date | 04/04/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174859870 | NPI | - | NPPES |
| 019028144 | Medicaid | IL | |
| 019027984 | Medicaid | IL | |
| 019028085 | Medicaid | IL | |
| 019028089 | Medicaid | IL | |
| 019028149 | Medicaid | IL | |
| 019028752 | Medicaid | IL |
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