Healthcare Provider Details

I. General information

NPI: 1538689062
Provider Name (Legal Business Name): SOUTHERN ILLINOIS MEDICAL SERVICES, NFP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2017
Last Update Date: 01/07/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98 PEACH RIDGE RD
ANNA IL
62906-2243
US

IV. Provider business mailing address

PO BOX 3988
CARBONDALE IL
62902-3988
US

V. Phone/Fax

Practice location:
  • Phone: 618-614-1400
  • Fax: 618-614-1401
Mailing address:
  • Phone: 618-457-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number StateIL

VIII. Authorized Official

Name: WARREN P LADNER
Title or Position: SENIOR VP CHIEF FINANCIAL OFFICER
Credential:
Phone: 618-457-5200