Healthcare Provider Details

I. General information

NPI: 1659287639
Provider Name (Legal Business Name): SOUTHERN ILLINOIS HOSPITAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 LINCOLN DR STE D
HERRIN IL
62948-6355
US

IV. Provider business mailing address

1239 E MAIN ST
CARBONDALE IL
62901-3175
US

V. Phone/Fax

Practice location:
  • Phone: 618-997-5652
  • Fax: 618-997-5751
Mailing address:
  • Phone: 618-457-5200
  • Fax: 618-529-0565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: SHANNON S HARTKE
Title or Position: CORPORATE DIRECTOR PFS
Credential:
Phone: 618-457-5200