Organization · Type 2 NPI

Shawnee Health Service and Development Corp

Federally Qualified Health Center (FQHC) · Marion, IL

NPI number 1114631967 Active

Practice location

700 E Boulevard St
Marion, IL 62959-3306

Call (618) 519-9200 Map

Fax (618) 998-0880

Mailing address

109 California St, PO Box 577
Carterville, IL 62918

Specialties and licenses

Taxonomy	Code	License
Mental Health Counselor	101YM0800X	None listed
Clinical Social Worker	1041C0700X	None listed
General Practice Dentistry	1223G0001X	None listed
Dental Hygienist	124Q00000X	None listed
Family Medicine Physician	207Q00000X	None listed
Federally Qualified Health Center (FQHC) Primary	261QF0400X	None listed

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

2 other providers at this address

Other federally qualified health center (fqhc) providers in Marion

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NPI record

NPI: 1114631967
Entity type: Organization (Type 2)
Issued: Jan 6, 2023
Last updated: Jul 29, 2024
Status: Active
Subpart: Yes of Shawnee Health Service and Development Corp

Other names

<unavail>
Jefferson Elementary School Health Center · doing business as
Jefferson Elementary School Health Center · 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 1114631967

Shawnee Health Service and Development Corp's National Provider Identifier is 1114631967, issued on Jan 6, 2023. The primary taxonomy on file is Federally Qualified Health Center (FQHC) (261QF0400X), and the practice location is in Marion, IL. The record was last updated on Jul 29, 2024.