Healthcare Provider Details

I. General information

NPI: 1992196752
Provider Name (Legal Business Name): NEW HORIZONS MEDICAL ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2015
Last Update Date: 02/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 W JACKSON ST SUITE 100
CARBONDALE IL
62901-1474
US

IV. Provider business mailing address

305 W JACKSON ST SUITE 100
CARBONDALE IL
62901-1474
US

V. Phone/Fax

Practice location:
  • Phone: 618-529-2834
  • Fax: 618-457-0440
Mailing address:
  • Phone: 618-529-2834
  • Fax: 618-457-0440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. ANN ELIZABETH DARLING
Title or Position: PRACTICE MANAGER
Credential:
Phone: 618-529-2834