Healthcare Provider Details

I. General information

NPI: 1639148067
Provider Name (Legal Business Name): CARMI MEDICAL CENTER SERVICE INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 W MAIN ST
CARMI IL
62821-1387
US

IV. Provider business mailing address

1400 W MAIN ST
CARMI IL
62821-1387
US

V. Phone/Fax

Practice location:
  • Phone: 618-382-4181
  • Fax: 618-382-3590
Mailing address:
  • Phone: 618-382-4181
  • Fax: 618-382-3590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. DAVID J STRICKLIN
Title or Position: PRESIDENT OWNER
Credential: M.D.
Phone: 618-382-4181