Basic Information
| Provider Information | |||||||||
| NPI: | 1245442375 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUTHERN ILLINOIS HAND CENTER, SC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 901 MEDICAL PARK DRIVE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | EFFINGHAM | ||||||||
| State: | IL | ||||||||
| PostalCode: | 62401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2173473003 | ||||||||
| FaxNumber: | 2173473005 | ||||||||
| Practice Location | |||||||||
| Address1: | 901 MEDICAL PARK DRIVE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | EFFINGHAM | ||||||||
| State: | IL | ||||||||
| PostalCode: | 62401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2173473003 | ||||||||
| FaxNumber: | 2173473005 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2007 | ||||||||
| LastUpdateDate: | 04/04/2017 | ||||||||
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| AuthorizedOfficialLastName: | NAAM | ||||||||
| AuthorizedOfficialFirstName: | NASH | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2173473003 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0105X | 36067047 | IL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery | Surgery of the Hand |
ID Information
| ID | Type | State | Issuer | Description | 2500075 | 01 | BCBS IL | OTHER | DA0723 | 01 | RAILROAD MEDICARE | OTHER |