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General NPI Number Information
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NPI Number | 1053804443
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Entity Type | Organization
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Legal Business Name | SIU PHYSICIANS & SURGEONS, INC
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Dates
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Enumeration Date | 06/11/2018
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Last Update Date | 09/25/2018
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Provider Practice Location Address
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Address Line | 610 N WESTGATE AVE
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City | JACKSONVILLE
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State | IL
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Zip | 62650-1152
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Country | US
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Telephone | 217-243-8455
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 19639
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City | SPRINGFIELD
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State | IL
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Zip | 62794-9639
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Country | US
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Telephone | 217-545-7876
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Fax |
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Authorized Official
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Title or Position | MEDICAL STAFF COORDINATOR
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Name | JO TURLEY
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Credential |
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Telephone | 217-545-7876
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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