SHAWNEE HEALTH SERVICE AND DEVELOPMENT CORP (NPI# 1356677058) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1356677058 |
| Entity Type | Organization |
| Organization Name | SHAWNEE HEALTH SERVICE AND DEVELOPMENT CORP |
| Other Organization Name | SHAWNEE HEALTH CARE, MARION DENTAL |
| Practice Address |
3115 Williamson County Pkwy Marion IL 62959-5235 |
| Mailing Address |
109 California Street Po Box 577 Carterville IL 62918-0577 |
| Practice Telephone | 6189698600 |
| Practice Fax Number | 6189978978 |
| Mailing Telephone | 6189858221 |
| Mailing Fax Number | 6189856860 |
| Enumeration Date | 2009-10-30 |
| Last Update Date | 2016-12-23 |
| Authorized Official Name | PATSY JENSEN (CEO) |
| Authorized Official Telephone | 6189858221 |
| Is Organization Subpart | Y |
| Parent Organization Name | SHAWNEE HEALTH SERVICE AND DEVELOPMENT CORP |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 122300000X | Dentist | IL | Dental Providers | |
| N | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
IL | Dental Providers | |
| N | 124Q00000X | Dental Hygienist | IL | Dental Providers | |
| N | 126800000X | Dental Assistant | IL | Dental Providers | |
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Shawnee Health Care, Marion Dental | 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 |
| 1285185173 | Shawnee Health Service and Development Corp | Social Worker | 404 S. Lewis Lane, Carbondale, IL 62901 | 2016-10-17 |
| 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 |
3115 WILLIAMSON COUNTY PKWY |
| City | MARION |
| State | IL |
| Zip Code | 62959-5235 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508395849 | Ashish Nayak | Dentist | 3115 Williamson County Pkwy, Marion, IL 62959 | 2017-06-09 |
| 1174079891 | Julie E Burkeen | Dentist | 3115 Williamson County Pkwy, Marion, IL 62959-5235 | 2016-09-01 |
| 1962958686 | Bradley Cox | Dentist | 3115 Williamson County Pkwy, Marion, IL 62959-5235 | 2016-09-01 |
| 1932461639 | Eun Jin Lee | Dentist | 3115 Williamson County Pkwy, Marion, IL 62959-5235 | 2012-06-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710513486 | Sarah Benitone | Counselor | 11264 Il-37, Marion, IL 62959 | 2020-03-13 |
| 1528609328 | Patricia E Murphy | Radiology | 4503 1/2 W Deyoung, Suite 3a, Marion, IL 62959 | 2019-10-02 |
| 1366007007 | Centerstone of Illinois, Inc | Community/Behavioral Health | 202 S Bentley St, Marion, IL 62959 | 2019-05-08 |
| 1649752064 | Sydney Seiter | Occupational Therapist | 906 Skyline Suite 100, Marion, IL 62959 | 2018-09-01 |
| 1497279848 | Brooke Alisa Osman | Licensed Practical Nurse | 11531 Sunderland Road, Marion, IL 62959 | 2017-07-27 |
| 1912436429 | Joy L. Kee | Social Worker | 509 South Bentley Street, Marion, IL 62959 | 2017-06-08 |
| 1386181170 | Susan Smothers | Counselor | 1305 West Main Street, Marion, IL 62959 | 2017-01-31 |
| 1205280922 | Harish Kempegowda | Orthopaedic Surgery | 3331 W Deyoung St Ste 201, Marion, IL 62959 | 2016-04-19 |
| 1942609227 | Casey Hill | Social Worker | 1604 W. Walnut St., Marion, IL 62959 | 2014-08-22 |
| 1306252812 | Justin M White | Chiropractor | 1603 W Kimmel, Marion, IL 62959 | 2014-07-03 |
| Find all providers in zip 62959 | ||||
| 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 |
|---|---|---|---|---|
| 1437638038 | East Arkansas Family Health Center, Inc | Clinic/Center | 1 Patriot Dr, Marion, AR 72364-2408 | 2018-08-14 |
| 1346417417 | Center Street Community Clinic Inc | Clinic/Center | 205 W Center St, Suite 200, Marion, OH 43302-3700 | 2008-05-08 |
| 1437238151 | Rural Health Medical Program, Inc. | Clinic/Center | 1310 Washington Street, Marion, AL 36756-3218 | 2006-11-03 |
| 1881624161 | Shawnee Health Service and Development Corp | Clinic/Center | 1700 Wildcat Dr Ste A, Marion, IL 62959-1513 | 2006-07-03 |
| 1275150815 | Health Care Partners Pharmacy | Clinic/Center | 145 Palmetto Pointe Rd, Marion, SC 29571-6721 | 2020-06-30 |
| 1821440629 | Center Street Community Clinic Inc | Clinic/Center | 136 W Center St, Marion, OH 43302-3704 | 2016-07-06 |
| 1649609843 | Morehouse Community Medical Centers, Inc. | Clinic/Center | 335 Main Street, Marion, LA 71260-3653 | 2013-11-07 |
| 1780984211 | Center Street Community Clinic Inc | Clinic/Center | 136 W Center St, Marion, OH 43302-3704 | 2010-11-01 |
| 1770668824 | Health Care Partners of South Carolina, Inc. | Clinic/Center | 145 Palmetto Pointe Rd, Marion, SC 29571-3014 | 2006-10-26 |
| 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 |
| 1437708674 | Board of Trustees of Southern Illinois University | Clinic/Center | 300 W Oak Street, Carbondale, IL 62901 | 2019-09-10 |
| 1427600345 | The Board of Trustees of The University of Illinois | Clinic/Center | 6835 S Normal Blvd, Chicago, IL 60621-2535 | 2019-07-11 |
| Find all providers with the same taxonomy | ||||
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.