SHAWNEE HEALTH SERVICE AND DEVELOPMENT CORP (NPI# 1285185173) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1285185173 |
| Entity Type | Organization |
| Organization Name | SHAWNEE HEALTH SERVICE AND DEVELOPMENT CORP |
| Other Organization Name | SHAWNEE HEALTH CARE, SAME DAY |
| Practice Address |
404 S. Lewis Lane Carbondale IL 62901 |
| Mailing Address |
Po Box 577 109 California St. Carterville IL 62918-0577 |
| Practice Telephone | 6185199200 |
| Mailing Telephone | 6189858221 |
| Mailing Fax Number | 6189854635 |
| Enumeration Date | 2016-10-17 |
| Last Update Date | 2018-01-26 |
| Authorized Official Name | PATSY JENSEN (CEO) |
| Authorized Official Telephone | 6189569508 |
| Is Organization Subpart | Y |
| Parent Organization Name | SHAWNEE HEALTH SERVICE AND DEVELOPMENT CORP |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 104100000X | Social Worker | Behavioral Health & Social Service Providers | ||
| N | 207Q00000X | Family Medicine | H80CS00667 | IL | Allopathic & Osteopathic Physicians |
| N | 2084P0800X |
Psychiatry & Neurology Specialization: Psychiatry |
H80CS00667 | IL | Allopathic & Osteopathic Physicians |
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Shawnee Health Care, Same Day | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053878967 | Shawnee Health Service and Development Corp | Clinic/Center | 1025 N Wall St Rm 102, Carbondale, IL 62901-1737 | 2019-02-27 |
| 1699232512 | Shawnee Health Service and Development Corp | Clinic/Center | 801 S Lewis Ln Rm 153, Carbondale, IL 62901-3408 | 2019-02-27 |
| 1487111639 | Shawnee Health Service and Development Corp | Clinic/Center | 121 N Parrish Ln Rm 123, Carbondale, IL 62901-2024 | 2019-02-25 |
| 1841757242 | Shawnee Health Service and Development Corp | Clinic/Center | 1150 E Grand Ave Rm 127, Carbondale, IL 62901-3422 | 2019-02-22 |
| 1356677058 | Shawnee Health Service and Development Corp | Dentist | 3115 Williamson County Pkwy, Marion, IL 62959-5235 | 2009-10-30 |
| 1639295314 | Shawnee Health Service and Development Corp | Social Worker | 109 California St, Carterville, IL 62918-0577 | 2007-03-22 |
| 1326079245 | Shawnee Health Service and Development Corp | Clinic/Center | 1301 E Walnut St Rm J120, Carbondale, IL 62901-5004 | 2006-07-06 |
| 1881624161 | Shawnee Health Service and Development Corp | Clinic/Center | 1700 Wildcat Dr Ste A, Marion, IL 62959-1513 | 2006-07-03 |
| 1902447196 | Shawnee Health Service and Development Corp | Clinic/Center | 101 S Wall St, Carbondale, IL 62901-3021 | 2019-09-30 |
| 1306497052 | Shawnee Health Service and Development Corp | Clinic/Center | 1506 Sioux Dr, Marion, IL 62959-5209 | 2019-09-24 |
| Street Address |
404 S. LEWIS LANE |
| City | CARBONDALE |
| State | IL |
| Zip Code | 62901 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558961268 | Gerad Aaron Harsy | Pharmacist | Walmart Pharmcy, 1450 East Main St, Carbondale, IL 62901 | 2020-10-30 |
| 1437708674 | Board of Trustees of Southern Illinois University | Clinic/Center | 300 W Oak Street, Carbondale, IL 62901 | 2019-09-10 |
| 1306317383 | Rachael O Johnson | Nurse Practitioner | 404 S. Lewis Ln, Carbondale, IL 62901 | 2018-12-17 |
| 1740795194 | Megan Marie Zimmerman | Nurse Practitioner | 1100 W Diann Ln., Carbondale, IL 62901 | 2017-12-07 |
| 1295244242 | Amy Elizabeth Prudencio | Social Worker | 1301 E. Walnut Street, Carbondale, IL 62901 | 2017-09-21 |
| 1740708171 | Theresa Aleise Goodin | Speech-Language Pathologist | 1301 East Walnut Street, Carbondale, IL 62901 | 2017-09-06 |
| 1144762527 | Kathleen Chwalisz Rigney | Psychologist | 306 West Mill Street, Neurorestorative, Carbondale, IL 62901 | 2016-11-16 |
| 1437605094 | Arielle Greer | Nurse's Aide | 510 E. Russell St., A, Carbondale, IL 62901 | 2016-09-01 |
| 1518413863 | Complete Family Eyecare of Carbondale, PC | Optometrist | 1241 East Walnut Street, Carbondale, IL 62901 | 2016-08-28 |
| 1174919351 | Southern Illinois University Carbondale Clinical Center | Psychologist | 625 Wham Drive Room 141, Carbondale, IL 62901 | 2015-04-14 |
| Find all providers in zip 62901 | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568073229 | Mountain Family Health Centers | Clinic/Center | 2270 Highway 133, Carbondale, CO 81623-9271 | 2020-08-14 |
| 1437708674 | Board of Trustees of Southern Illinois University | Clinic/Center | 300 W Oak Street, Carbondale, IL 62901 | 2019-09-10 |
| 1053878967 | Shawnee Health Service and Development Corp | Clinic/Center | 1025 N Wall St Rm 102, Carbondale, IL 62901-1737 | 2019-02-27 |
| 1699232512 | Shawnee Health Service and Development Corp | Clinic/Center | 801 S Lewis Ln Rm 153, Carbondale, IL 62901-3408 | 2019-02-27 |
| 1487111639 | Shawnee Health Service and Development Corp | Clinic/Center | 121 N Parrish Ln Rm 123, Carbondale, IL 62901-2024 | 2019-02-25 |
| 1841757242 | Shawnee Health Service and Development Corp | Clinic/Center | 1150 E Grand Ave Rm 127, Carbondale, IL 62901-3422 | 2019-02-22 |
| 1326079245 | Shawnee Health Service and Development Corp | Clinic/Center | 1301 E Walnut St Rm J120, Carbondale, IL 62901-5004 | 2006-07-06 |
| 1316939929 | Community Health & Emergency Services, Inc. | Clinic/Center | 1340 Cedar Ct, Carbondale, IL 62901-5336 | 2005-08-19 |
| 1073572350 | Community Health & Emergency Services, Inc | Clinic/Center | 1250 Cedar Ct, Carbondale, IL 62901-5334 | 2006-03-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417567108 | Pillars Community Health | Clinic/Center | 15w458 91st St, Burr Ridge, IL 60527-6379 | 2020-08-06 |
| 1932724390 | Friend Family Health Center, Inc | Clinic/Center | 7355 S Jeffery Blvd, Chicago, IL 60649-3121 | 2020-06-11 |
| 1871117937 | Primecare Community Health Inc | Clinic/Center | 1431 N Western Ave Ste 101, Chicago, IL 60622-7712 | 2020-06-04 |
| 1639791569 | Community Health Partnership of Illinois | Clinic/Center | 201 W Kenyon Rd Bldg D, Champaign, IL 61820-7892 | 2020-05-14 |
| 1407482219 | Access Community Health Network | Clinic/Center | 6020 W Diversey Ave Bldg West, Chicago, IL 60639-1108 | 2020-03-13 |
| 1235769704 | Greater Elgin Family Care Center | Clinic/Center | 451 N Mclean Blvd, Elgin, IL 60123-3239 | 2020-01-23 |
| 1710517537 | Greater Elgin Family Care Center Integrated Health Home | Clinic/Center | 1100 Shirley Ave, Streamwood, IL 60107-3068 | 2020-01-21 |
| 1215578109 | Board of Trustees of Southern Illinois University | Clinic/Center | 205 S 24th St Ste 100, Quincy, IL 62301-4446 | 2019-10-02 |
| 1427600345 | The Board of Trustees of The University of Illinois | Clinic/Center | 6835 S Normal Blvd, Chicago, IL 60621-2535 | 2019-07-11 |
| 1922561000 | Heartland Community Health Clinic | Clinic/Center | 2116 N Sheridan Rd # 104, Peoria, IL 61604-3457 | 2019-04-07 |
| Find all providers with the same taxonomy | ||||
| City | CARBONDALE |
| Zip Code | 62901 |
Please comment or provide details below to improve the information on SHAWNEE HEALTH SERVICE AND DEVELOPMENT CORP.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.