Healthcare Provider Details

I. General information

NPI: 1811954944
Provider Name (Legal Business Name): SOUTHERN ILLINOIS SLEEP INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 01/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 AIRWAY DR
MARION IL
62959-5872
US

IV. Provider business mailing address

PO BOX 797090
SAINT LOUIS MO
63179-7000
US

V. Phone/Fax

Practice location:
  • Phone: 618-997-5500
  • Fax: 618-997-5501
Mailing address:
  • Phone: 314-645-5855
  • Fax: 314-645-6446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. ANITA G. HOPKIN
Title or Position: BILLING MANAGER
Credential: R.PSG.T.
Phone: 314-645-5855