Provider Demographics
NPI:1639148067
Name:CARMI MEDICAL CENTER SERVICE INCORPORATED
Entity Type:Organization
Organization Name:CARMI MEDICAL CENTER SERVICE INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:STRICKLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:618-382-4181
Mailing Address - Street 1:1400 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CARMI
Mailing Address - State:IL
Mailing Address - Zip Code:62821-1387
Mailing Address - Country:US
Mailing Address - Phone:618-382-4181
Mailing Address - Fax:618-382-3590
Practice Address - Street 1:1400 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CARMI
Practice Address - State:IL
Practice Address - Zip Code:62821-1387
Practice Address - Country:US
Practice Address - Phone:618-382-4181
Practice Address - Fax:618-382-3590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-16
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========002Medicaid
IL148939Medicare Oscar/Certification
IL=========002Medicaid
IL589280Medicare PIN