CENTER FOR MEDICAL ARTS RURAL HEALTH
Complete NPI Record 1154510808
Clinic/Center - Rural Health in Carbondale, IL
Active since October 18, 2007CLIA Certified · 2 labs
Complete NPI Dataset
This page contains the complete raw NPPES record for Center For Medical Arts Rural Health (NPI 1154510808), a clinic/center organization in Carbondale, IL. All 32 fields on file are listed with their current values and official NPPES definitions, exactly as recorded in the National Plan and Provider Enumeration System. Only fields that contain data are included, so the number of fields shown varies from one NPI record to another.
Use the tools below to filter fields by category, search within the record, or jump straight to a specific field. You can download the full record as a CSV, JSON, or text file, or filter first and export only the fields you need. The Print Clean Summary button produces a printer-friendly copy of the record.
Registry File Document Utilities
- NPI: 1154510808 Field 1/32
- The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
- Entity Type Code: 2 Field 2/32
- Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
- Employer Identification Number EIN: Not available Field 3/32
- The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
- Provider Organization Name Legal Business Name: SOUTHERN ILLINOIS MEDICAL SERVICES, NFP Field 4/32
- The name of the organization provider. If the provider is an organization, this is the legal business name.
- Provider Other Organization Name: CENTER FOR MEDICAL ARTS RURAL HEALTH Field 5/32
- Other name by which the organization provider is or has been known.
- Provider Other Organization Name Type Code: 3 Field 6/32
- Code identifying the type of other name. Codes are: 1 = former name; 2 = professional name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other.
- Provider First Line Business Mailing Address: PO BOX 3988 Field 7/32
- The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
- Provider Business Mailing Address City Name: CARBONDALE Field 8/32
- The city name in the mailing address of the provider being identified.
- Provider Business Mailing Address State Name: IL Field 9/32
- The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
- Provider Business Mailing Address Postal Code: 629023988 Field 10/32
- The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
- Provider Business Mailing Address Country Code If outside U S : US Field 11/32
- The country code in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address country code".
- Provider Business Mailing Address Telephone Number: 6184575200 Field 12/32
- The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".
- Provider First Line Business Practice Location Address: 2601 W MAIN ST Field 13/32
- The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
- Provider Business Practice Location Address City Name: CARBONDALE Field 14/32
- The city name in the location address of the provider being identified.
- Provider Business Practice Location Address State Name: IL Field 15/32
- The State code in the location of the provider being identified.
- Provider Business Practice Location Address Postal Code: 629011031 Field 16/32
- The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
- Provider Business Practice Location Address Country Code If outside U S : US Field 17/32
- The country code in the location address of the provider being identified.
- Provider Business Practice Location Address Telephone Number: 6185495361 Field 18/32
- The telephone number associated with the location address of the provider being identified.
- Provider Business Practice Location Address Fax Number: 6183514878 Field 19/32
- The fax number associated with the location address of the provider being identified.
- Authorized Official Last Name: LADNER Field 22/32
- The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
- Authorized Official First Name: WARREN Field 23/32
- The first name of the authorized official.
- Authorized Official Middle Name: P Field 24/32
- The middle name of the authorized official.
- Authorized Official Title or Position: SENIOR VP CHIEF FINANCIAL OFFICER Field 25/32
- The title or position of the authorized official.
- Authorized Official Telephone Number: 6184575200 Field 26/32
- The 10-position telephone number of the authorized official.
- Healthcare Provider Taxonomy Code 1: 261QR1300X Field 27/32
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Healthcare Provider Primary Taxonomy Switch 1: Y Field 28/32
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Is Organization Subpart: Y Field 29/32
- Indicates whether the provider is a subpart of a larger organization. This is a single-character code: "Y" means the entity is an organizational subpart, while "N" means it is not. Subparts typically include hospital departments, clinics, or other distinct units that fall under a parent organization.
- Parent Organization LBN: SOUTHERN ILLINOIS HOSPITAL SERVICES Field 30/32
- The Legal Business Name (LBN) of the parent organization, if the provider is a subpart of a larger entity. This field identifies the official registered name of the parent company or organization under which the provider operates.
- Parent Organization TIN: Not available Field 31/32
- The Taxpayer Identification Number (TIN) of the parent organization, provided when the provider is a subpart of a larger entity. This field identifies the federal tax ID used by the parent organization for official and billing purposes.
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