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General NPI Number Information
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NPI Number | 1154408581
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Entity Type | Organization
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Legal Business Name | SOUTHERN ILLINOIS HOSPITAL SERVICES
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 01/07/2025
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Provider Practice Location Address
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Address Line | 2553 KEN GRAY BLVD
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City | WEST FRANKFORT
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State | IL
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Zip | 62896-4174
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Country | US
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Telephone | 618-932-3937
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Fax | 618-932-2734
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Provider Business Mailing Address
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Address Line | PO BOX 3988
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City | CARBONDALE
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State | IL
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Zip | 62902-3988
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Country | US
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Telephone | 618-457-5200
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Fax |
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Authorized Official
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Title or Position | SENIOR VP CHIEF FINANCIAL OFFICER
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Name | WARREN P LADNER
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Credential |
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Telephone | 618-457-5200
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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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Taxonomy #2
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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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