Healthcare Provider Details

I. General information

NPI: 1558367177
Provider Name (Legal Business Name): SOUTHERN ILLINOIS GERIATRICS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9409 HOLY CROSS LN
BREESE IL
62230-3510
US

IV. Provider business mailing address

9409 HOLY CROSS LN
BREESE IL
62230-3510
US

V. Phone/Fax

Practice location:
  • Phone: 618-526-7399
  • Fax: 618-526-7399
Mailing address:
  • Phone: 618-526-7399
  • Fax: 618-526-7399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: LINDA G UHRIG
Title or Position: OWNER/PHYSICIAN
Credential: MD
Phone: 618-526-7399