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General NPI Number Information
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NPI Number | 1699838276
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Entity Type | Organization
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Legal Business Name | SOUTHERN ILLINOIS OB-GYN ASSOCIATES, S.C.
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Dates
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Enumeration Date | 12/18/2006
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Last Update Date | 12/06/2022
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Provider Practice Location Address
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Address Line | 500 RUSHING DR
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City | HERRIN
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State | IL
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Zip | 62948-3748
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Country | US
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Telephone | 618-998-8808
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Fax |
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Provider Business Mailing Address
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Address Line | 500 RUSHING DR
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City | HERRIN
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State | IL
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Zip | 62948-3748
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Country | US
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Telephone | 618-998-8808
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | HEATHER HUDSON
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Credential |
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Telephone | 618-998-8808
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 |
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