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Organization
THE CARBONDALE CLINIC AMBULATORY SURGICAL TREATMENT CENTER
Active
Organization
THE CARBONDALE CLINIC AMBULATORY SURGICAL TREATMENT CENTER
Active
Parent organization
CARBONDALE CLINIC, S.C.
Organization subpart
Yes
Provider details
NPI number
Legal business name
CARBONDALE CLINIC, S.C.
Authorized official
MR. ALLAN N NORMAN (CHIEF EXECUTIVE OFFICER)
(618) 457-5200
Entity
Organization
Contact information
Practice address
2601 W MAIN ST, CARBONDALE, IL 62901-1031
(618) 549-5361
(618) 549-5128
Mailing address
2601 W MAIN ST, CARBONDALE, IL 62901-1031
(618) 549-5361
(618) 549-5128
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
7001019
IL
Other
Enumeration date
12/29/2006
Last updated
05/09/2008
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