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Organization
THE CARBONDALE CLINIC
Active
Organization
THE CARBONDALE CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ALLAN NORMAN (CHIEF EXECUTIVE OFFICER)
(618) 457-5200
Entity
Organization
Contact information
Practice address
2601 W MAIN ST, CARBONDALE, IL 62901-1031
(618) 457-5200
(618) 549-5128
Mailing address
2601 W MAIN ST, CARBONDALE, IL 62901-1031
(618) 457-5200
(618) 457-4542
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
042-000266
IL
Other
Enumeration date
12/05/2006
Last updated
05/08/2008
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