Organization
THE CARBONDALE CLINIC RADIOLOGY
Active
Parent organization
THE CARBONDALE CLINIC, S.C.
Organization subpart
Yes
Provider details
NPI number
Legal business name
THE 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) 457-5200
(618) 549-5128
Mailing address
2601 W MAIN ST, CARBONDALE, IL 62901-1031
(618) 457-5200
(618) 549-5128
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
044651
HAMP
IL
01
—
196090
GHP
IL
01
—
464790
HEALTHLINK
IL
01
—
614350
LEGACY
IL
01
—
690006448
RR MEDICARE
IL
Enumeration date
12/29/2006
Last updated
05/08/2008
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