NPI:
1073745345
Provider Name:
SHAWNEE HEALTH SERVICE AND DEVELOPMENT CORP
Doing Business As: SHAWNEE HEALTH CARE, CARBONDALE
Classification:
Clinic/Center - 261QF0400X
Entity Type:
Organization
Specialization: Federally Qualified Health Center (FQHC)
CLIA Number: 14D2000480
Address:
400 S LEWIS LN
CARBONDALE, IL
ZIP 62901
Phone:
(618) 519-9900
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SHAWNEE HEALTH SERVICE AND DEVELOPMENT CORP is a federally qualified health center (fqhc) clinic center in Carbondale, IL. SHAWNEE HEALTH SERVICE AND DEVELOPMENT CORP NPI is 1073745345. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Shawnee Health Care, Carbondale.
The provider's business location address is:
400 S LEWIS LN
CARBONDALE, IL
ZIP 62901-547
Phone: (618) 519-9900
Fax: (618) 519-9961
The provider's authorized official is Christina Carney .
The authorized official title is Ceo and has the following contact phone number (618) 956-9521.
The CLIA number assigned to this NPI record is 14D2000480 - federally qualified health center with a certificate type of Certificate of Waiver.
The enumeration date for this NPI number is 8/20/2009 and was last updated on 4/4/2024.