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General NPI Number Information
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NPI Number | 1447318050
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Entity Type | Organization
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Legal Business Name | SOUTHERN ILLINOIS RADIATION ONCOLOGY LLC
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Dates
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Enumeration Date | 12/05/2006
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Last Update Date | 03/04/2019
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Provider Practice Location Address
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Address Line | 1400 PIN OAK DR
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City | CARTERVILLE
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State | IL
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Zip | 62918-1600
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Country | US
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Telephone | 618-985-3333
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Fax | 618-985-1315
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Provider Business Mailing Address
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Address Line | 600 WEST MAIN STREET SUITE 3
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City | CARBONDALE
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State | IL
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Zip | 62901-2604
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Country | US
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Telephone | 618-529-3159
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Fax | 618-351-9909
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | MICHAEL LITTLE
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Credential | MD
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Telephone | 618-985-3333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number |
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License Number State |
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