Provider Demographics
NPI:1619058278
Name:CHARLES F EDDINGFIELD MD
Entity Type:Organization
Organization Name:CHARLES F EDDINGFIELD MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:F
Authorized Official - Last Name:EDDINGFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:217-357-3715
Mailing Address - Street 1:PO BOX 100
Mailing Address - Street 2:25 SOUTH ADAMS STREET
Mailing Address - City:CARTHAGE
Mailing Address - State:IL
Mailing Address - Zip Code:62321
Mailing Address - Country:US
Mailing Address - Phone:217-357-3715
Mailing Address - Fax:
Practice Address - Street 1:25 SOUTH ADAMS STREET
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:IL
Practice Address - Zip Code:62321
Practice Address - Country:US
Practice Address - Phone:217-357-3715
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36038782208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0161162451Medicaid
272470Medicare ID - Type Unspecified
IL0161162451Medicaid