|
| |
|
402 S. Lewis Lane Carbondale IL 62901 | |
| (618) 519-9901 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 402 S. Lewis Lane, Carbondale, Illinois |
| Authorized Official Name and Position | Christina Carney (CEO) |
| Authorized Official Contact | 6189569521 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
109 California St Po Box 577 Carterville IL 62918-1923 Ph: (618) 985-8221 | 402 S. Lewis Lane Carbondale IL 62901 Ph: (618) 519-9901 |
| NPI Number | 1174859870 |
|---|---|
| Provider Enumeration Date | 10/30/2009 |
| Last Update Date | 04/04/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174859870 | NPI | - | NPPES |
| 019028144 | Medicaid | IL | |
| 019027984 | Medicaid | IL | |
| 019028085 | Medicaid | IL | |
| 019028089 | Medicaid | IL | |
| 019028149 | Medicaid | IL | |
| 019028752 | Medicaid | IL |
Southern Illinois University Carbondale Dental Sealant Program Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 1365 Douglas Dr Rm 18, Casa, Sah, Mc 6615, Carbondale, IL 62901 Phone: 618-453-7211 Fax: 618-453-7020 | |
Oakland Dental Care P.c. Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 305 S Oakland Ave, Carbondale, IL 62901 Phone: 618-549-2166 Fax: 618-529-4128 | |
Little Egypt Pediatric Dentistry Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 1255 Cedar Ct, Carbondale, IL 62901 Phone: 618-319-4536 |