NPIMap

Organization Active NPI

The Carbondale Clinic Ambulatory Surgical Treatment Center

  • Ambulatory Surgical Clinic/Center
  • Carbondale, IL
National Provider Identifier
1679639918
Registry record updated May 9, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
7001019 Issued in IL
Legal business name
THE CARBONDALE CLINIC AMBULATORY SURGICAL TREATMENT CENTER
Practice address
2601 W Main St
Carbondale, IL 62901-1031
Phone
(618) 549-5361
Fax
(618) 549-5128
NPI assigned
Dec 29, 2006
Organization subpart
Yes
Parent organization
CARBONDALE CLINIC, S.C.As reported in NPPES

NPPES NPI Registry

Updated by the provider on May 9, 2008

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

Authorized official

Name
Mr. Allan N Norman
Title
Chief Executive Officer
Phone
(618) 457-5200

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X 7001019 IL Primary

Addresses

Primary practice location

2601 W Main St
Carbondale, IL 62901-1031

Mailing address

2601 W Main St
Carbondale, IL 62901-1031
Phone (618) 549-5361

Other identifiers 6

IdentifierTypeStateIssuer
490000473OtherILRAILROAD MEDICARE NUMBER
014101OtherILHAMP
116485OtherILHEALTHLINK
141028OtherILMEDICARE GROUP NUMBER
196077OtherILGHP
533OtherILBCBS

National Provider Directory

National Provider Directory
Tax ID family
Carbondale Clinic Satellite5 organizations share this tax ID, including this one
Part of
Carbondale Clinic Satellite

Other organizations with this tax ID 4

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

NPI Registry JSON

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

{
    "created_epoch": "1167350400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1210291200000",
    "number": "1679639918",
    "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": "618-549-5361",
            "fax_number": "618-549-5128"
        },
        {
            "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": "618-549-5361",
            "fax_number": "618-549-5128"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE CARBONDALE CLINIC AMBULATORY SURGICAL TREATMENT CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CARBONDALE CLINIC, S.C.",
        "enumeration_date": "2006-12-29",
        "last_updated": "2008-05-09",
        "status": "A",
        "authorized_official_last_name": "NORMAN",
        "authorized_official_first_name": "ALLAN",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "618-457-5200",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "IL",
            "license": "7001019",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE NUMBER",
            "identifier": "490000473",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HAMP",
            "identifier": "014101",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHLINK",
            "identifier": "116485",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP NUMBER",
            "identifier": "141028",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GHP",
            "identifier": "196077",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "533",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Carbondale, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 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.