CLS Medical Inc.

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

CLS MEDICAL INC.

Practice address

200 S Broadway
Goreville, IL 62939-2447

Phone

(618) 995-2396

Fax

(618) 995-2947

NPI assigned

Jun 18, 2007

Organization subpart

No

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

Authorized official

Name

Crystal L Stangle, MSHED CEO

Title

Owner Ceo

Phone

(618) 995-2396

Specialties & licenses 1

Addresses

Other names 1

• Goreville Family Practice Doing business as

Practitioners 3

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

• Sally J Ballard, PA-C

  • Medical Physician Assistant
  • Goreville, IL
  • NPI 1720288756
  NPD (past)
• Jogendra Singh Chhabra, MD

  • General Practice Physician
  • Norris City, IL
  • NPI 1043343569
  NPD (past)
• Michael W Adams, MD

  • Emergency Medicine Physician
  • Great Falls, MT
  • NPI 1770576555
  NPD (past)

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

{
    "created_epoch": "1182124800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1790980985",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 40",
            "address_2": "200 SOUTH BROADWAY STREET",
            "city": "GOREVILLE",
            "state": "IL",
            "postal_code": "629390040",
            "telephone_number": "618-995-2396",
            "fax_number": "618-995-2947"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 S BROADWAY",
            "city": "GOREVILLE",
            "state": "IL",
            "postal_code": "629392447",
            "telephone_number": "618-995-2396",
            "fax_number": "618-995-2947"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLS MEDICAL INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-18",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "STANGLE",
        "authorized_official_first_name": "CRYSTAL",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER CEO",
        "authorized_official_telephone_number": "618-995-2396",
        "authorized_official_credential": "MSHED CEO"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Goreville Family Practice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• William J Banz
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• Blake William Cain, MD, MS
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• Matthew Camarato, RPH
• Amber Conyea, PTA
• Counseling for a Change
• CR Vaughn Inc
• Emily A Finke, DMD
• Amanda Mae Lorene Fowler Test

• All providers in Goreville, IL
• Primary Care Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.