| Southern Illinois Foot And Ankle Clinic Ltd | |
| 
					1235 Cedar Ct, Carbondale, IL 62901-5335  | |
| (618) 457-0431 | |
| (618) 457-5199 | 
| Full Name | Southern Illinois Foot And Ankle Clinic Ltd | 
|---|---|
| Type | Facility | 
| Speciality | Podiatrist | 
| Location | 1235 Cedar Ct, Carbondale, Illinois | 
| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. | 
| Identifier | Type | State | Issuer | 
|---|---|---|---|
| 1134224199 | NPI | - | NPPES | 
| 016003389 | Medicaid | IL | |
| 016005370 | Medicaid | IL | |
| 016004187 | Medicaid | IL | |
| 1013941392 | Other | IL | RAILROAD MEDICARE | 
| 1972533933 | Other | IL | RAILROAD MEDICARE | 
| CI5845 | Other | IL | RAILROAD MEDICARE | 
| Taxonomy | Type | License (State) | Status | 
|---|---|---|---|
| 213E00000X | Podiatrist | 016003389 (Illinois) | Primary | 
| Provider Name | Christopher C Moore | 
|---|---|
| Provider Type | Practitioner - Podiatry | 
| Provider Identifiers | NPI Number: 1013941392 PECOS PAC ID: 7810968476 Enrollment ID: I20061219000490  | 
| Mailing Address | Practice Location Address | 
|---|---|
| Southern Illinois Foot And Ankle Clinic Ltd Po Box 997, Carbondale, IL 62903-0997 Ph: (618) 457-0431  | Southern Illinois Foot And Ankle Clinic Ltd 1235 Cedar Ct, Carbondale, IL 62901-5335 Ph: (618) 457-0431  | 
Christopher C Moore, D.P.M. Podiatrist Medicare: Accepting Medicare Assignments Practice Location: 1235 Cedar Ct, Carbondale, IL 62901 Phone: 618-457-0431 Fax: 618-457-5199  | |
Basil H Hazimah, DPM Podiatrist Medicare: Not Enrolled in Medicare Practice Location: 1235 Cedar Ct, Carbondale, IL 62901 Phone: 618-457-0431 Fax: 618-457-5199  |