1245442375 NPI number — SOUTHERN ILLINOIS HAND CENTER, SC

Table of content: (NPI 1245442375)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245442375 NPI number — SOUTHERN ILLINOIS HAND CENTER, SC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHERN ILLINOIS HAND CENTER, SC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245442375
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/04/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
901 MEDICAL PARK DRIVE
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
EFFINGHAM
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
217-347-3003
Provider Business Mailing Address Fax Number:
217-347-3005

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
901 MEDICAL PARK DRIVE
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
EFFINGHAM
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-347-3003
Provider Business Practice Location Address Fax Number:
217-347-3005
Provider Enumeration Date:
05/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
NAAM
Authorized Official First Name:
NASH
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
217-347-3003

Provider Taxonomy Codes

  • Taxonomy code: 2086S0105X , with the licence number:  36067047 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2500075 . This is a "BCBS IL" identifier . This identifiers is of the category "OTHER".
  • Identifier: DA0723 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




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