SHAWNEE HEALTH CARE, CARBONDALE DENTAL – NPI #1174859870
Clinic/Center

SHAWNEE HEALTH CARE, CARBONDALE DENTAL is an AHC clinic located in CARBONDALE, IL. NPPES has assigned the NPI number 1174859870 to SHAWNEE HEALTH CARE, CARBONDALE DENTAL on October 30, 2009. It is a Type-2 NPI, indicating this NPI number is associated with an organization. Since the name “SHAWNEE HEALTH CARE, CARBONDALE DENTAL” is a dba name, the actual legal business name for this organization is SHAWNEE HEALTH SERVICE & DEVELOPMENT CORP. With multiple taxonomy codes selected, the primary taxonomy selected by this provider is 261QF0400X from the Health Care Provider Taxonomy code set, which is classified as Clinic/Center, specializing in Federally Qualified Health Center (FQHC) Bear in mind that having a taxonomy code selected doesn't replace any credentialing or validation process that may be required by law.

The NPI profile was previously updated about 2 years ago on Apr 04, 2024. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for SHAWNEE HEALTH CARE, CARBONDALE DENTAL below.

NPI Profile for
SHAWNEE HEALTH SERVICE & DEVELOPMENT CORP

NPI Number
1174859870
Enumeration Date

(more than 16 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
SHAWNEE HEALTH SERVICE & DEVELOPMENT CORP
Doing Business As (dba): SHAWNEE HEALTH CARE, CARBONDALE DENTAL
Primary location
402 S. LEWIS LANE
CARBONDALE, IL 62901
Phone: (618) 519-9901 Fax:
Mailing address
109 CALIFORNIA ST
PO BOX 577
CARTERVILLE, IL 62918-1923
Phone: (618) 985-8221 Fax: (618) 985-6860
Organization Subpart
Yes - SHAWNEE HEALTH CARE, CARBONDALE DENTAL is subpart of another organization.
Authorized Official
CHRISTINA CARNEY
CEO
Phone: (618) 956-9521
Updated
Certification Date
Apr 04, 2024

Note: NPPES allows providers to attest to the accuracy of their NPI data. When a provider request any change to the NPI record, they will be able to attest to their changed NPI data, resulting in an updated certification date.

Identifiers

Identifiers for SHAWNEE HEALTH CARE, CARBONDALE DENTAL

Identifiers are used to associate other provider identifiers such as Medicaid or other insurers (ie:, Blue Cross, Blue Shield, Aetna, Kaiser-Permanente, etc.), with their NPI number. These identifiers can be used in matching an NPI number to an insurer's records. However, not all providers have such numbers and not all providers choose to include them in their NPI information.

See identifiers
DescriptionIssuerStateIdentifier
medicaidIL019028089
medicaidIL019028149
medicaidIL019028085
medicaidIL019028144
medicaidIL019028752
medicaidIL019027984
Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
261QF0400X
- Clinic/Center / Federally Qualified Health Center (FQHC) (Primary)
126800000X
- Dental Assistant		 IL
124Q00000X
- Dental Hygienist		 IL
1223P0221X
- Dentist / Pediatric Dentistry		 IL
122300000X
- Dentist		 IL

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.