Basic Information
| Provider Information | |||||||||
| NPI: | 1942849096 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SIU PHYSICIANS & SURGEONS, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 19639 | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 627949639 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2175457876 | ||||||||
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| Practice Location | |||||||||
| Address1: | 720 N BOND ST | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 627024952 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2175457876 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/06/2020 | ||||||||
| LastUpdateDate: | 01/06/2020 | ||||||||
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| AuthorizedOfficialLastName: | TURLEY | ||||||||
| AuthorizedOfficialFirstName: | JO | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEDICAL STAFF COORDINATOR | ||||||||
| AuthorizedOfficialTelephone: | 2175457876 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 01/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | N | Suppliers | Durable Medical Equipment & Medical Supplies | 332BC3200X | Y | Suppliers | Durable Medical Equipment & Medical Supplies | Customized Equipment |
No ID Information.