Healthcare Provider Details

I. General information

NPI: 1033948674
Provider Name (Legal Business Name): SIGMA INNOVATION GROUP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2024
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20558 E 1400TH AVE
TEUTOPOLIS IL
62467-3644
US

IV. Provider business mailing address

PO BOX 144
TEUTOPOLIS IL
62467-0144
US

V. Phone/Fax

Practice location:
  • Phone: 217-343-4108
  • Fax: 615-628-0823
Mailing address:
  • Phone: 217-343-4108
  • Fax: 615-628-0823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOHN NEIHLS
Title or Position: CEO
Credential:
Phone: 217-343-4108