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General NPI Number Information
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NPI Number | 1093739435
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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 | 07/27/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 701 N 1ST ST D235
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City | SPRINGFIELD
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State | IL
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Zip | 62781-0001
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Country | US
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Telephone | 217-545-7578
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Fax | 217-545-1884
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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 | 217-545-7578
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Fax | 217-545-1884
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Authorized Official
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Title or Position | CEO
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Name | DAVID TKACH
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Credential |
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Telephone | 217-545-7578
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number |
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 207VX0201X
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Taxonomy Name | Gynecologic Oncology Physician
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License Number |
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number |
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License Number State | IL
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Taxonomy #5
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Taxonomy Code | 207VM0101X
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Taxonomy Name | Maternal & Fetal Medicine Physician
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License Number |
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License Number State | IL
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Taxonomy #6
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Taxonomy Code | 207VX0000X
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Taxonomy Name | Obstetrics Physician
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License Number |
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License Number State | IL
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Taxonomy #7
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Taxonomy Code | 207VE0102X
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Taxonomy Name | Reproductive Endocrinology Physician
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License Number |
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License Number State | IL
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Taxonomy #8
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State | IL
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