MEDICARE: SOUTHERN ILLINOIS HEMATOLOGY ONCOLOGY LTD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

General Provider Information

NPI Number	:	1346348364
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHERN ILLINOIS HEMATOLOGY ONCOLOGY LTD

Provider Business Mailing Address
First Line	:	220 S PARK AVE
Second Line	:	PO BOX 667
City	:	HERRIN
State	:	IL
Zip	:	62948-3612
Country	:	US
Telephone Number	:	618-942-8822
Fax Number	:	618-942-4477

Provider Business Practice Location Address
First Line	:	220 S PARK AVE
Second Line	:
City	:	HERRIN
State	:	IL
Zip	:	62948-3612
Country	:	US
Telephone Number	:	618-942-8822
Fax Number	:	618-942-4477

Authorized Official
Title or Position	:	CEO
Name	:	ALI FALOUDI
Credential	:
Telephone Number	:	618-942-8822

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	05/10/2010

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