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General NPI Number Information
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NPI Number | 1982845137
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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 | 03/18/2009
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Last Update Date | 03/18/2009
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Provider Practice Location Address
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Address Line | 203 BAILEY LN
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City | BENTON
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State | IL
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Zip | 62812-1969
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Country | US
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Telephone | 618-438-5670
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Fax | 618-438-5709
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Provider Business Mailing Address
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Address Line | 203 BAILEY LN
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City | BENTON
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State | IL
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Zip | 62812-1969
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Country | US
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Telephone | 618-438-5670
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Fax | 618-438-5709
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MR. REX P BUDDE
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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 |
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License Number State |
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