Organization · Type 2 NPI

Shawnee Health Service and Development Corp

Federally Qualified Health Center (FQHC) · Carterville, IL

NPI number 1053002907 Active

Practice location

6355 Brandhorst Rd
Carterville, IL 62918-3322

Call (618) 519-9200 Map

Fax (618) 985-9096

Mailing address

PO Box 577
Carterville, IL 62918-0577

Specialties and licenses

Taxonomy	Code	License
Mental Health Counselor	101YM0800X	None listed
Clinical Social Worker	1041C0700X	None listed
Federally Qualified Health Center (FQHC) Primary	261QF0400X	None listed

Federally Qualified Health Center (FQHC): Definition to come...

Another provider at this address

Ryan Rogulich, LCSWClinical Social Worker Carterville, IL NPI 1427713403

Other federally qualified health center (fqhc) providers in Carterville

See all in Carterville →

NPI record

NPI: 1053002907
Entity type: Organization (Type 2)
Issued: May 19, 2023
Last updated: Jul 16, 2024
Status: Active
Subpart: Yes of Shawnee Health Service and Development Corp

Other names

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Shawnee Health Social Services · doing business as
Shawnee Health Social Services · doing business as

Authorized official

Christina Carney
CEO
(618) 956-9521

Verify this record

This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1053002907

Shawnee Health Service and Development Corp's National Provider Identifier is 1053002907, issued on May 19, 2023. The primary taxonomy on file is Federally Qualified Health Center (FQHC) (261QF0400X), and the practice location is in Carterville, IL. The record was last updated on Jul 16, 2024.