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General NPI Number Information
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NPI Number | 1720033046
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Entity Type | Organization
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Legal Business Name | SILOAM LLC
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Dates
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Enumeration Date | 05/24/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 10286 FLEMING RD
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City | CARTERVILLE
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State | IL
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Zip | 62918-3351
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Country | US
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Telephone | 918-985-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 171 TECHNOLOGY DR SUITE 200
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City | BOALSBURG
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State | PA
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Zip | 16827-1530
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Country | US
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Telephone | 814-237-8627
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Fax | 814-238-0083
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Authorized Official
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Title or Position | OWNER
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Name | JACK T SANDFORD
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Credential | MD
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Telephone | 618-985-4000
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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 | IL
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