| The Carbondale Clinic | |
|
2601 W Main St Carbondale IL 62901-1031 | |
| (618) 457-5200 | |
| (618) 549-5128 |
| Full Name | The Carbondale Clinic |
|---|---|
| Speciality | Clinic/center - Multi-specialty |
| Location | 2601 W Main St, Carbondale, Illinois |
| Authorized Official Name and Position | Allan Norman (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 6184575200 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| The Carbondale Clinic 2601 W Main St Carbondale IL 62901-1031 Ph: (618) 457-5200 | The Carbondale Clinic 2601 W Main St Carbondale IL 62901-1031 Ph: (618) 457-5200 |
| NPI Number | 1043378565 |
|---|---|
| Provider Enumeration Date | 12/05/2006 |
| Last Update Date | 05/08/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043378565 | NPI | - | NPPES |
| 3910515 | Other | IL | BCBS |
| 690006448 | Other | IL | RAILROAD MEDICARE |
| 614350 | Other | IL | LEGACY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | 042-000266 (Illinois) | Primary |
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