Organization Name: | SHAWNEE HEALTH SERVICE AND DEVELOPMENT CORP |
NPI Number: | 1811928732 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | PATSY JENSEN (CEO) |
Mailing Address: | 1006 S Division St Carterville |
State: | IL US |
Postal Code: | 629181539 |
Phone Number: | 6189854841 |
Fax Number: | 6189858101 |
NPI Enumeration Date: | 07/06/2006 |
NPI Last Update Date: | 05/29/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 207VX0000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | IL |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | Obstetrics & Gynecology |
Taxonomy Specialization: | Obstetrics |
Taxonomy Definition: |