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NPI Code Detail

MEDICARE: KIDNEY CARE SERVICES OF SOUTHERN ILLINOIS, LTD

MEDICARE: KIDNEY CARE SERVICES OF SOUTHERN ILLINOIS, LTD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QM2500XMedical Specialty Clinic/Center036102569IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1669501912
Entity Type Code : Organization
Provider Name (Legal Business Name) : KIDNEY CARE SERVICES OF SOUTHERN ILLINOIS, LTD
Provider Business Mailing Address
First Line : PO BOX 181
Second Line :
City : DU QUOIN
State : IL
Zip : 62832-0181
Country : US
Telephone Number : 618-542-3048
Fax Number : 618-542-3097
Provider Business Practice Location Address
First Line : 900 N WASHINGTON ST
Second Line :
City : DU QUOIN
State : IL
Zip : 62832-1230
Country : US
Telephone Number : 618-542-3048
Fax Number : 618-542-3097
Authorized Official
Title or Position : OWNER
Name : DR. MOHAMMAD S SHAFI
Credential : MC
Telephone Number : 618-542-3048
Provider Enumeration Date : 03/05/2007
Last Update Date : 08/12/2008

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Directions to “KIDNEY CARE SERVICES OF SOUTHERN ILLINOIS, LTD ” Practice Location

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