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General NPI Number Information
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NPI Number | 1881401941
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Entity Type | Organization
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Legal Business Name | SOUTHERN ILLINOIS EMERGENCY MEDICAL SERVICES
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Dates
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Enumeration Date | 12/12/2024
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Last Update Date | 01/27/2025
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Provider Practice Location Address
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Address Line | 1003 W CHERRY ST
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City | MARION
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State | IL
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Zip | 62959-1913
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Country | US
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Telephone | 618-340-1179
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Fax | 580-628-2267
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Provider Business Mailing Address
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Address Line | 121 N 8TH ST
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City | DUPO
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State | IL
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Zip | 62239-1514
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Country | US
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Telephone | 618-340-1179
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Fax | 580-628-2267
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | BRENDA BUTLER
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Credential |
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Telephone | 618-340-1179
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number |
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License Number State |
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