| Organization Name: | THE CARBONDALE CLINIC |
| NPI Number: | 1043378565 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ALLAN NORMAN (CHIEF EXECUTIVE OFFICER) |
| Mailing Address: | 2601 W Main St Carbondale |
| State: | IL US |
| Postal Code: | 629011031 |
| Phone Number: | 6184575200 |
| Fax Number: | 6185495128 |
| NPI Enumeration Date: | 12/05/2006 |
| NPI Last Update Date: | 05/08/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QM1300X |
| License Number: | 042-000266 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Multi-Specialty |
| Taxonomy Definition: | |