| Shawnee Health Care, Carbondale | |
|
400 S Lewis Ln Carbondale IL 62901-3547 | |
| (618) 519-9900 | |
| (618) 519-9961 |
| Full Name | Shawnee Health Care, Carbondale |
|---|---|
| Speciality | Clinic/Center |
| Location | 400 S Lewis Ln, 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 Care, Carbondale 109 California St Po Box 577 Carterville IL 62918-1923 Ph: (618) 985-8221 | Shawnee Health Care, Carbondale 400 S Lewis Ln Carbondale IL 62901-3547 Ph: (618) 519-9900 |
| NPI Number | 1073745345 |
|---|---|
| Provider Enumeration Date | 08/20/2009 |
| Last Update Date | 04/04/2024 |
| Medicare PECOS PAC ID | 1658285671 |
|---|---|
| Medicare Enrollment ID | O20100119000507 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073745345 | NPI | - | NPPES |
| CF3444 | Other | IL | MEDICARE RR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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