Organization · Type 2 NPI

Shawnee Health Service & Development Corp

Federally Qualified Health Center (FQHC) · Carbondale, IL

NPI number 1174859870 Active

Practice location

402 S. Lewis Lane
Carbondale, IL 62901

Call (618) 519-9901 Map

Mailing address

109 California St, PO Box 577
Carterville, IL 62918-1923

Specialties and licenses

TaxonomyCodeLicense
Dentist 122300000XNone listed
Pediatric Dentistry 1223P0221XNone listed
Dental Hygienist 124Q00000XNone listed
Dental Assistant 126800000XNone listed
Federally Qualified Health Center (FQHC) Primary 261QF0400XNone listed

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

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About NPI 1174859870

Shawnee Health Service & Development Corp's National Provider Identifier is 1174859870, issued on Oct 30, 2009. The primary taxonomy on file is Federally Qualified Health Center (FQHC) (261QF0400X), and the practice location is in Carbondale, IL. The record was last updated on Apr 4, 2024.