| Shawnee Health Service And Development Corp | |
|
1025 N Wall St Rm 102 Carbondale IL 62901-1737 | |
| (618) 519-9200 | |
| Not Available |
| Full Name | Shawnee Health Service And Development Corp |
|---|---|
| Speciality | Clinic/Center |
| Location | 1025 N Wall St Rm 102, Carbondale, Illinois |
| Authorized Official Name and Position | Christina Carney (CEO) |
| Authorized Official Contact | 6189569521 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Shawnee Health Service And Development Corp 109 California St. Po Box 577 Carterville IL 62918-0577 Ph: (618) 985-8221 | Shawnee Health Service And Development Corp 1025 N Wall St Rm 102 Carbondale IL 62901-1737 Ph: (618) 519-9200 |
| NPI Number | 1053878967 |
|---|---|
| Provider Enumeration Date | 02/27/2019 |
| Last Update Date | 07/29/2024 |
| Certification Date | 07/29/2024 |
| Medicare PECOS PAC ID | 1658285671 |
|---|---|
| Medicare Enrollment ID | O20230505002023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053878967 | NPI | - | NPPES |
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