Southern Illinois Foot And Ankle Clinic Ltd | |
1235 Cedar Ct, Carbondale, IL 62901-5335 | |
(618) 457-0431 | |
(618) 457-5199 |
Full Name | Southern Illinois Foot And Ankle Clinic Ltd |
---|---|
Type | Facility |
Speciality | Podiatrist |
Location | 1235 Cedar Ct, Carbondale, Illinois |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1134224199 | NPI | - | NPPES |
016003389 | Medicaid | IL | |
016005370 | Medicaid | IL | |
016004187 | Medicaid | IL | |
1013941392 | Other | IL | RAILROAD MEDICARE |
1972533933 | Other | IL | RAILROAD MEDICARE |
CI5845 | Other | IL | RAILROAD MEDICARE |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
213E00000X | Podiatrist | 016003389 (Illinois) | Primary |
Provider Name | Christopher C Moore |
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Provider Type | Practitioner - Podiatry |
Provider Identifiers | NPI Number: 1013941392 PECOS PAC ID: 7810968476 Enrollment ID: I20061219000490 |
Mailing Address | Practice Location Address |
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Southern Illinois Foot And Ankle Clinic Ltd Po Box 997, Carbondale, IL 62903-0997 Ph: (618) 457-0431 | Southern Illinois Foot And Ankle Clinic Ltd 1235 Cedar Ct, Carbondale, IL 62901-5335 Ph: (618) 457-0431 |
Christopher C Moore, D.P.M. Podiatrist Medicare: Accepting Medicare Assignments Practice Location: 1235 Cedar Ct, Carbondale, IL 62901 Phone: 618-457-0431 Fax: 618-457-5199 | |
Basil H Hazimah, DPM Podiatrist Medicare: Not Enrolled in Medicare Practice Location: 1235 Cedar Ct, Carbondale, IL 62901 Phone: 618-457-0431 Fax: 618-457-5199 |