Organization · Type 2 NPI

Shawnee Health Service and Development Corp

Federally Qualified Health Center (FQHC) · Carbondale, IL

NPI number 1285185173 Active

Practice location

404 S. Lewis Lane
Carbondale, IL 62901

Call (618) 519-9200 Map

Fax (618) 549-1288

Mailing address

PO Box 577, 109 California St.
Carterville, IL 62918-0577

Specialties and licenses

TaxonomyCodeLicense
Counselor 101Y00000XNone listed
Clinical Social Worker 1041C0700XNone listed
Family Medicine Physician 207Q00000XH80CS00667 (IL)
Psychiatry Physician 2084P0800XH80CS00667 (IL)
Federally Qualified Health Center (FQHC) Primary 261QF0400XNone listed

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

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About NPI 1285185173

Shawnee Health Service and Development Corp's National Provider Identifier is 1285185173, issued on Oct 17, 2016. 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 Aug 5, 2024.