MEDICARE: SOUTHERN ILLINOIS ACUTE CARE CONSULTANTS,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
1	207RP1001X	Pulmonary Disease Physician	036105971	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	290014938	OTHER	IL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	081851	OTHER	IL	HEALTH ALLIANCE
2	04132005	OTHER	IL	BCBS
3	264630	OTHER	IL	HEALTHLINK
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780807594
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHERN ILLINOIS ACUTE CARE CONSULTANTS,LTD

Provider Business Mailing Address
First Line	:	4106 SOUTH WATER TOWER PLACE
Second Line	:
City	:	MOUNT VERNON
State	:	IL
Zip	:	62864-6544
Country	:	US
Telephone Number	:	618-242-8900
Fax Number	:	618-242-8967

Provider Business Practice Location Address
First Line	:	4106 SOUTH WATER TOWER PLACE
Second Line	:
City	:	MOUNT VERNON
State	:	IL
Zip	:	62864-6544
Country	:	US
Telephone Number	:	618-242-8900
Fax Number	:	618-242-8967

Authorized Official
Title or Position	:	PRESIDENT-PHYSICIAN
Name	:	DR. ANTHONY C VACCA
Credential	:	D.O.
Telephone Number	:	618-242-8900

Provider Enumeration Date	:	04/10/2007
Last Update Date	:	06/10/2008

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Directions to “SOUTHERN ILLINOIS ACUTE CARE CONSULTANTS,LTD ” Practice Location

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