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General NPI Number Information
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NPI Number | 1518285295
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Entity Type | Organization
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Legal Business Name | CARLINVILLE MEDICAL CLINIC, INC.
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Dates
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Enumeration Date | 05/05/2010
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Last Update Date | 08/08/2022
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Provider Practice Location Address
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Address Line | 604 N BROAD ST
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City | CARLINVILLE
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State | IL
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Zip | 62626-1021
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Country | US
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Telephone | 217-854-9411
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Fax | 217-854-2858
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Provider Business Mailing Address
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Address Line | 604 N BROAD
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City | CARLINVILLE
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State | IL
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Zip | 62626-1608
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Country | US
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Telephone | 217-854-9411
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Fax | 217-854-2858
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. MARGIE BUSBY
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Credential |
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Telephone | 217-854-9411
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 036057724
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License Number State | IL
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