Healthcare Provider Details

I. General information

NPI: 1780310391
Provider Name (Legal Business Name): ALBANY CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2022
Last Update Date: 09/24/2022
Certification Date: 09/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 ALBANY RD
CARBONDALE IL
62903-7646
US

IV. Provider business mailing address

35 ALBANY RD
CARBONDALE IL
62903-7646
US

V. Phone/Fax

Practice location:
  • Phone: 888-804-4330
  • Fax: 217-275-5768
Mailing address:
  • Phone: 888-804-4330
  • Fax: 217-275-5768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: SYLVIA GARWIN
Title or Position: PRACTICE MANAGER
Credential: MD
Phone: 888-804-4330