| Southern Illinois Medical Services, Nfp | |
|
117 E Clark St Harrisburg IL 62946-2702 | |
| (618) 252-8625 | |
| (618) 351-4859 |
| Full Name | Southern Illinois Medical Services, Nfp |
|---|---|
| Speciality | Clinic/Center |
| Location | 117 E Clark St, Harrisburg, Illinois |
| Authorized Official Name and Position | Warren P Ladner (SENIOR VP CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 6184575200 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southern Illinois Medical Services, Nfp Po Box 3988 Carbondale IL 62902-3988 Ph: (618) 457-5200 | Southern Illinois Medical Services, Nfp 117 E Clark St Harrisburg IL 62946-2702 Ph: (618) 252-8625 |
| NPI Number | 1750705364 |
|---|---|
| Provider Enumeration Date | 02/18/2014 |
| Last Update Date | 01/07/2025 |
| Medicare PECOS PAC ID | 3678677390 |
|---|---|
| Medicare Enrollment ID | O20140317001075 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750705364 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | 036042756 (Illinois) | Primary |
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