# THE CARBONDALE CLINIC AMBULATORY SURGICAL TREATMENT CENTER

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** CARBONDALE CLINIC, S.C.
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1679639918
- **Legal business name:** CARBONDALE CLINIC, S.C.
- **Authorized official:** MR. ALLAN N NORMAN (CHIEF EXECUTIVE OFFICER)
- **Authorized official phone:** (618) 457-5200

## Contact information

- **Practice address:** 2601 W MAIN ST, CARBONDALE, IL 62901-1031
- **Practice address phone:** (618) 549-5361
- **Practice address fax:** (618) 549-5128
- **Mailing address:** 2601 W MAIN ST, CARBONDALE, IL 62901-1031
- **Mailing address phone:** (618) 549-5361
- **Mailing address fax:** (618) 549-5128

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | 7001019 | IL | Yes |

## Other

- **Enumeration date:** 12/29/2006
- **Last updated:** 05/09/2008