| Organization Name: | CARLINVILLE MEDICAL CLINIC, INC. |
| NPI Number: | 1730213026 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | BENITA L RAUZI (OFFICE MANAGER) |
| Mailing Address: | 604 N. Broad Carlinville |
| State: | IL US |
| Postal Code: | 62626 |
| Phone Number: | 2178549411 |
| Fax Number: | 2178542858 |
| NPI Enumeration Date: | 03/16/2007 |
| NPI Last Update Date: | 05/05/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 209000907 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | IL |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |