Provider Demographics
NPI:1730213026
Name:CARLINVILLE MEDICAL CLINIC, INC.
Entity type:Organization
Organization Name:CARLINVILLE MEDICAL CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE & BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BUSBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-854-9411
Mailing Address - Street 1:604 N. BROAD
Mailing Address - Street 2:
Mailing Address - City:CARLINVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62626
Mailing Address - Country:US
Mailing Address - Phone:217-854-9411
Mailing Address - Fax:217-854-2858
Practice Address - Street 1:604 N. BROAD
Practice Address - Street 2:
Practice Address - City:CARLINVILLE
Practice Address - State:IL
Practice Address - Zip Code:62626
Practice Address - Country:US
Practice Address - Phone:217-854-9411
Practice Address - Fax:217-854-2858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036057724207Q00000X
IL209000907363LF0000X
261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036057724Medicaid
IL036057724Medicaid
IL=========001Medicaid
ILC45428Medicare UPIN
ILK23646Medicare PIN
IL624840Medicare ID - Type Unspecified
IL148978Medicare Oscar/Certification
ILL83383Medicare PIN