NPIMap

Organization Active NPI

Shawnee Health Service and Development Corp

  • Community/Retail Pharmacy
  • Carbondale, IL
National Provider Identifier
1760253447
Registry record updated Jul 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
SHAWNEE HEALTH SERVICE AND DEVELOPMENT CORP
Practice address
400 S Lewis LN Ste 200
Carbondale, IL 62901-3547
Phone
(618) 519-9200
NPI assigned
Jan 11, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 26, 2024

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

Authorized official

Name
Christina Carney
Title
Chief Executive Officer
Phone
(618) 956-9521

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X Primary

Addresses

Primary practice location

400 S Lewis LN Ste 200
Carbondale, IL 62901-3547

Mailing address

400 S Lewis LN Ste 200
Carbondale, IL 62901-3547
Phone (618) 519-9200

Other names 1

  • Shawnee Health Pharmacy Carbondale Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240815000243 IL Part B Supplier - Pharmacy 1658285671 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Carbondale, IL; Murphysboro, IL

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Grand Tower Health Cent36 organizations share this tax ID, including this one

Other organizations with this tax ID 35

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

View all 35

Locations

1301 E Walnut St
Rm J120
Carbondale, IL 62901
Phone (618) 457-3371

1335 Cedar Ct
Carbondale, IL 62901
Phone (618) 457-5753

202 W Jackson St
Carbondale, IL 62901
Phone (618) 457-0465

801 S Lewis Ln
Rm 153
Carbondale, IL 62901

700 E Boulevard St
Rm C23
Marion, IL 62959

1400 W Hendrickson St
Marion, IL 62959

6 E Shawnee Dr
#B
Murphysboro, IL 62966
Phone (618) 648-9100

6 E Shawnee Dr
Ste 2
Murphysboro, IL 62966
Phone (618) 684-9100

Practitioners & affiliated clinicians

Practitioners 85

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 85

NPI Registry JSON

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

{
    "created_epoch": "1704931200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721952000000",
    "number": "1760253447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 S LEWIS LN STE 200",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629013547",
            "telephone_number": "618-519-9200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 S LEWIS LN STE 200",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629013547",
            "telephone_number": "618-519-9200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHAWNEE HEALTH SERVICE AND DEVELOPMENT CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-11",
        "last_updated": "2024-07-26",
        "certification_date": "2024-07-26",
        "status": "A",
        "authorized_official_last_name": "CARNEY",
        "authorized_official_first_name": "CHRISTINA",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "618-956-9521"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shawnee Health Pharmacy Carbondale",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Shawnee Health Pharmacy Carbondale",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Jul 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.