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General NPI Number Information
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NPI Number | 1134530173
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Entity Type | Organization
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Legal Business Name | SOUTHERN ILLINOIS MEDICAL SPECIALISTS, LLC
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Dates
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Enumeration Date | 05/13/2014
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Last Update Date | 05/13/2014
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Provider Practice Location Address
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Address Line | 107 W FRANKLIN ST
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City | SESSER
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State | IL
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Zip | 62884-1456
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Country | US
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Telephone | 618-625-2105
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Fax | 618-625-2108
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Provider Business Mailing Address
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Address Line | 107 W FRANKLIN ST
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City | SESSER
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State | IL
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Zip | 62884-1456
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Country | US
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Telephone | 618-625-2105
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Fax | 618-625-2108
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Authorized Official
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Title or Position | CEO/OWNER
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Name | DR. LEE PETER BEE
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Credential | D.O., F.A.C.O.I.
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Telephone | 618-625-2105
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 202C00000X
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Taxonomy Name | Independent Medical Examiner Physician
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License Number | 036125672
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 204D00000X
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Taxonomy Name | Neuromusculoskeletal Medicine & OMM Physician
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License Number | 036125672
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | 036125672
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 036125672
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License Number State | IL
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Taxonomy #5
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 14D2034829
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License Number State | IL
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Taxonomy #6
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 036125672
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License Number State | IL
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