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General NPI Number Information
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NPI Number | 1326775594
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Entity Type | Organization
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Legal Business Name | ALAMO WOMEN'S CLINIC OF ILLINOIS LLC
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Dates
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Enumeration Date | 08/06/2022
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Last Update Date | 10/19/2023
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Provider Practice Location Address
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Address Line | 2800 W MAIN ST
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City | CARBONDALE
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State | IL
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Zip | 62901-1087
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Country | US
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Telephone | 800-821-7237
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Fax |
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Provider Business Mailing Address
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Address Line | 2800 W MAIN ST
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City | CARBONDALE
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State | IL
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Zip | 62901-1087
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Country | US
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Telephone | 618-351-2253
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE ADMINISTRATOR
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Name | ANDREA GALLEGOS
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Credential | LMSW
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Telephone | 210-842-9069
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QA0005X
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Taxonomy Name | Ambulatory Family Planning Facility
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License Number |
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License Number State |
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