SHAWNEE HEALTH SERVICE AND DEVELOPMENT CORP NPI 1639295314

NPI Information

NPI: 1639295314
Provider Name: SHAWNEE HEALTH SERVICE AND DEVELOPMENT CORP
Classification: Clinic/Center - 261QF0400X
Entity Type: Organization

Specialization: Federally Qualified Health Center (FQHC)

Address:
109 CALIFORNIA ST
CARTERVILLE, IL
ZIP 62918
Phone: (618) 985-8221
Get Directions

SHAWNEE HEALTH SERVICE AND DEVELOPMENT CORP is a federally qualified health center (fqhc) clinic center in Carterville, IL. SHAWNEE HEALTH SERVICE AND DEVELOPMENT CORP NPI is 1639295314. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

109 CALIFORNIA ST
CARTERVILLE, IL
ZIP 62918-577
Phone: (618) 985-8221
Fax: (618) 985-6860

The provider's authorized official is Christina Carney .
The authorized official title is Ceo and has the following contact phone number (618) 956-9521.

The enumeration date for this NPI number is 3/22/2007 and was last updated on 4/5/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License State	Primary
1	1041C0700X	Social Worker	Clinical	ILLINOIS	No
2	122300000X	Dentist		ILLINOIS	No
3	124Q00000X	Dental Hygienist		ILLINOIS	No
4	126800000X	Dental Assistant		ILLINOIS	No
5	133V00000X	Dietitian, Registered		ILLINOIS	No
6	207Q00000X	Family Medicine		ILLINOIS	No
7	207QA0000X	Family Medicine	Adolescent Medicine	ILLINOIS	No
8	207RP1001X	Internal Medicine	Pulmonary Disease	ILLINOIS	No
9	207V00000X	Obstetrics & Gynecology		ILLINOIS	No
10	208000000X	Pediatrics		ILLINOIS	No
11	2084N0400X	Psychiatry & Neurology	Neurology	ILLINOIS	No
12	261QF0400X	Clinic/Center	Federally Qualified Health Center (FQHC)		Yes
13	3336C0003X	Pharmacy	Community/Retail Pharmacy	ILLINOIS	No

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	022	MEDICAID	ILLINOIS
2	020	MEDICAID	ILLINOIS
3	640701	OTHER		MEDICARE PART B GROUP ID
4	10032052	OTHER	ILLINOIS	BLUE CROSS BLUE SHIELD
5	CF3444	OTHER	ILLINOIS	MEDICARE RAILROAD
6	013	MEDICAID	ILLINOIS
7	024	MEDICAID	ILLINOIS
8	018	MEDICAID	ILLINOIS
9	019	MEDICAID	ILLINOIS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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