CARBONDALE RURAL HEALTH CLINIC NPI 1417013095

NPI Information

NPI: 1417013095
Provider Name: CARBONDALE RURAL HEALTH CLINIC
Classification: Clinic/Center - 261QR1300X
Entity Type: Organization

Specialization: Rural Health

CLIA Number: 14D2043807

Address:
2601 W MAIN ST
CARBONDALE, IL
ZIP 62901
Phone: (618) 549-5361
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CARBONDALE RURAL HEALTH CLINIC is a rural health clinic center in Carbondale, IL. CARBONDALE RURAL HEALTH CLINIC NPI is 1417013095. The provider is registered as an organization entity type.

The provider's business location address is:

2601 W MAIN ST
CARBONDALE, IL
ZIP 62901-031
Phone: (618) 549-5361
Fax: (618) 549-5128

The provider's authorized official is Allan N Norman .
The authorized official title is Chief Executive Officer and has the following contact phone number (618) 549-5361.

The CLIA number assigned to this NPI record is 14D2043807 - community clinic with a certificate type of Certificate of Accreditation.

The enumeration date for this NPI number is 12/28/2006 and was last updated on 4/20/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QR1300X	Clinic/Center	Rural Health			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State
1	143821	MEDICARE PIN	ILLINOIS
2	=========002	MEDICAID	ILLINOIS
3	143821	MEDICARE OSCAR/CERTIFICATION	ILLINOIS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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