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General NPI Number Information
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NPI Number | 1932192622
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Entity Type | Organization
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Legal Business Name | SOUTHWEST ILLINOIS HEALTH SERVICES, LLP
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Dates
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Enumeration Date | 08/26/2005
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Last Update Date | 07/18/2019
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Provider Practice Location Address
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Address Line | 4000 NORTH ILLINOIS SUITE A
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City | SWANSEA
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State | IL
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Zip | 62226-1496
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Country | US
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Telephone | 618-236-9770
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Fax | 618-236-9780
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Provider Business Mailing Address
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Address Line | 4000 NORTH ILLINOIS SUITE A
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City | SWANSEA
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State | IL
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Zip | 62226-1496
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Country | US
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Telephone | 618-236-9770
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Fax | 618-236-9780
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | JANE GUSMANO
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Credential |
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Telephone | 618-257-5607
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085N0904X
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Taxonomy Name | Nuclear Radiology Physician
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License Number | IL-01836-01
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License Number State | IL
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