Organization
SHAWNEE HEALTH SERVICE AND DEVELOPMENT CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTINA CARNEY (CEO)
(618) 956-9521
Entity
Organization
Contact information
Practice address
109 CALIFORNIA ST, CARTERVILLE, IL 62918-0577
(618) 985-8221
(618) 985-6860
Mailing address
109 CALIFORNIA ST, P O BOX 577, CARTERVILLE, IL 62918-0577
(618) 985-8221
(618) 985-6860
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
—
IL
122300000X
Dentist
—
IL
124Q00000X
Dental Hygienist
—
IL
126800000X
Dental Assistant
—
IL
133V00000X
Registered Dietitian
—
IL
207Q00000X
Family Medicine Physician
—
IL
207QA0000X
Adolescent Medicine (Family Medicine) Physician
—
IL
207RP1001X
Pulmonary Disease Physician
—
IL
207V00000X
Obstetrics & Gynecology Physician
—
IL
208000000X
Pediatrics Physician
—
IL
2084N0400X
Neurology Physician
—
IL
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
3336C0003X
Community/Retail Pharmacy
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
013
—
IL
05
—
018
—
IL
05
—
019
—
IL
05
—
020
—
IL
05
—
022
—
IL
05
—
024
—
IL
01
—
10032052
BLUE CROSS BLUE SHIELD
IL
01
—
640701
MEDICARE PART B GROUP ID
—
01
—
CF3444
MEDICARE RAILROAD
IL
Enumeration date
03/22/2007
Last updated
04/05/2024
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