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NPI Code Detail

MEDICARE: SHAWNEE HEALTH SERVICE AND DEVELOPMENT CORP

MEDICARE: SHAWNEE HEALTH SERVICE AND DEVELOPMENT CORP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor
21041C0700XClinical Social Worker
3207V00000XObstetrics & Gynecology Physician
4261QF0400XFederally Qualified Health Center (FQHC)

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2CF3444OTHERILMEDICARE RAILROAD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
110032052OTHERILBCBS

General Provider Information

NPI Number : 1457381774
Entity Type Code : Organization
Provider Name (Legal Business Name) : SHAWNEE HEALTH SERVICE AND DEVELOPMENT CORP
Provider Business Mailing Address
First Line : 109 CALIFORNIA ST
Second Line : P O BOX 577
City : CARTERVILLE
State : IL
Zip : 62918-0577
Country : US
Telephone Number : 618-985-8221
Fax Number : 618-985-6860
Provider Business Practice Location Address
First Line : 101 S WALL ST
Second Line :
City : CARBONDALE
State : IL
Zip : 62901-3021
Country : US
Telephone Number : 618-519-9200
Fax Number : 618-519-9404
Authorized Official
Title or Position : CEO
Name : CHRISTINA CARNEY
Credential :
Telephone Number : 618-956-9521
Provider Enumeration Date : 07/03/2006
Last Update Date : 07/29/2024

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Directions to “SHAWNEE HEALTH SERVICE AND DEVELOPMENT CORP ” Practice Location

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