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General NPI Number Information
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NPI Number | 1477820900
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Entity Type | Organization
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Legal Business Name | SOUTHERN ILLINOIS MEDICAL SERVICES, NFP
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Dates
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Enumeration Date | 11/29/2011
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Last Update Date | 01/07/2025
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Provider Practice Location Address
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Address Line | 405 RUSHING DR
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City | HERRIN
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State | IL
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Zip | 62948-3730
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Country | US
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Telephone | 618-993-3300
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Fax | 618-993-0262
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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 | 036081556
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License Number State | IL
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