The Carbondale Clinic

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

License

042-000266 Issued in IL

Legal business name

THE CARBONDALE CLINIC

Practice address

2601 W Main St
Carbondale, IL 62901-1031

Phone

(618) 457-5200

Fax

(618) 549-5128

NPI assigned

Dec 5, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Allan Norman

Title

Chief Executive Officer

Phone

(618) 457-5200

Specialties & licenses 1

Addresses

Other identifiers 3

Tax ID family

Carvondale Clinic5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

• Carbondale Rural Health Clinic

  • Rural Health Clinic/Center
  • Carbondale, IL
  • NPI 1417013095
  NPD tax ID
• Clinic Laboratory

  • Clinical Medical Laboratory
  • Carbondale, IL
  • NPI 1336205913
  NPD tax ID
• The Carbondale Clinic Ambulatory Surgical Treatment Center

  • Ambulatory Surgical Clinic/Center
  • Carbondale, IL
  • NPI 1679639918
  NPD tax ID
• The Carbondale Clinic Radiology

  • Diagnostic Radiology Physician
  • Carbondale, IL
  • NPI 1285790519
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165276800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1210204800000",
    "number": "1043378565",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2601 W MAIN ST",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629011031",
            "telephone_number": "618-457-5200",
            "fax_number": "618-457-4542"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2601 W MAIN ST",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629011031",
            "telephone_number": "618-457-5200",
            "fax_number": "618-549-5128"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE CARBONDALE CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-05",
        "last_updated": "2008-05-08",
        "status": "A",
        "authorized_official_last_name": "NORMAN",
        "authorized_official_first_name": "ALLAN",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "618-457-5200",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "IL",
            "license": "042-000266",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "3910515",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "690006448",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LEGACY",
            "identifier": "614350",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Terri Tate, BA
• Emoni Tatum, MSW, LSW
• Melba Margaret Taylor, M.D.
• Victoria Faith Taylor, LSW
• Salem Najeh Thabet, MD
• The Carbondale Clinic Ambulatory Surgical Treatment Center
• The Carbondale Clinic DME
• The Carbondale Clinic Pharmacy
• The Carbondale Clinic Radiology
• The Little Resource Center Carbondale

• Multi-Specialty Clinic/Center in Carbondale, IL
• Providers in Carbondale, IL by specialty
• Multi-Specialty Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.