1487111639 NPI number — SHAWNEE HEALTH SERVICE AND DEVELOPMENT CORP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487111639 NPI number — SHAWNEE HEALTH SERVICE AND DEVELOPMENT CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHAWNEE HEALTH SERVICE AND DEVELOPMENT CORP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PARRISH ELEMENTARY SCHOOL HEALTH CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487111639
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/05/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
109 CALIFORNIA ST
Provider Second Line Business Mailing Address:
PO BOX 577
Provider Business Mailing Address City Name:
CARTERVILLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62918-0577
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
618-985-8221
Provider Business Mailing Address Fax Number:
618-985-6860

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
121 N PARRISH LN RM 123
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARBONDALE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62901-2024
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-519-9200
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/25/2019

Additional Information

Authorized Official

Authorized Official Last Name:
CARNEY
Authorized Official First Name:
CHRISTINA
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
618-956-9521

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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