SOUTHERN ILLINOIS MEDICAL PLAZA SC (NPI# 1578746228) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1578746228 |
| Entity Type | Organization |
| Organization Name | SOUTHERN ILLINOIS MEDICAL PLAZA SC |
| Practice Address |
2250 Reed Station Pkwy Ste 305 Carbondale IL 62901-3304 |
| Mailing Address |
2250 Reed Station Pkwy Carbondale IL 62901 |
| Practice Telephone | 6185291943 |
| Practice Fax Number | 6185492975 |
| Mailing Telephone | 6185291943 |
| Mailing Fax Number | 6185492975 |
| Enumeration Date | 2007-12-17 |
| Last Update Date | 2010-09-21 |
| Authorized Official Name | DR. STEVEN PATRICK BARRETT (PRESIDENT) |
| Authorized Official Telephone | 6185291943 |
| Authorized Official Credential | D.C. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207Q00000X | Family Medicine | 036093859 | IL | Allopathic & Osteopathic Physicians |
| N | 225100000X | Physical Therapist | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | ||
| N | 225700000X | Massage Therapist | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | ||
| Y | 111N00000X | Chiropractor | 038007699 | IL | Chiropractic Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | BCBS OF IL GROUP | 03932090 | 01 |
| Street Address |
2250 REED STATION PKWY STE 305 |
| City | CARBONDALE |
| State | IL |
| Zip Code | 62901-3304 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588748545 | Steven Patrick Barrett | Chiropractor | 2250 Reed Station Pkwy, Ste. 305, Carbondale, IL 62901 | 2006-10-25 |
| 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 |
| 1285185173 | Shawnee Health Service and Development Corp | Social Worker | 404 S. Lewis Lane, Carbondale, IL 62901 | 2016-10-17 |
| 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 |
| Find all providers in zip 62901 | ||||
| Taxonomy Code | 111N00000X |
| Grouping | Chiropractic Providers |
| Classification | Chiropractor |
| A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083996268 | David William Binversie | Chiropractor | 141 Fishback Rd, Carbondale, IL 62901-6325 | 2011-09-14 |
| 1487960035 | Align Healthcare LLC | Chiropractor | 1245 East Walnut St, Carbondale, IL 62901 | 2010-08-20 |
| 1467682757 | Andrew John Rivera | Chiropractor | 267 Brooklyn St., Suite A, Carbondale, PA 18404 | 2009-07-21 |
| 1477734135 | Carbondale Chiropractic Center Inc. | Chiropractor | 267 Brooklyn Street, Suite A, Carbondale, PA 18407-2829 | 2007-11-21 |
| 1235332628 | Osage County Chiropractic, P.a. | Chiropractor | 119 Main St Box 329, Carbondale, KS 66414 | 2007-06-06 |
| 1891856308 | Woodard Wellness Group LLC | Chiropractor | 1245 E Walnut St, Carbondale, IL 62901-5005 | 2006-12-12 |
| 1134288087 | Kent James Albrecht | Chiropractor | 326 Highway 133, Suite 270c, Carbondale, CO 81623-2507 | 2006-12-07 |
| 1487725115 | Gary L Latimer | Chiropractor | 267 Brooklyn St, Suite A, Carbondale, PA 18407-2836 | 2006-11-13 |
| 1205914181 | Brian E Woodard | Chiropractor | 100 N Glenview Dr, Suite 101, Carbondale, IL 62901-2275 | 2006-11-01 |
| 1588748545 | Steven Patrick Barrett | Chiropractor | 2250 Reed Station Pkwy, Ste. 305, Carbondale, IL 62901 | 2006-10-25 |
| Find all providers in CARBONDALE | ||||
| City | CARBONDALE |
| Zip Code | 62901 |
Please comment or provide details below to improve the information on SOUTHERN ILLINOIS MEDICAL PLAZA SC.
| 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.