| Southern Illinois Family Medicine Corporation | |
|
104 Magnolia Dr Ste A Glen Carbon IL 62034-1595 | |
| (618) 288-9466 | |
| Not Available |
| Full Name | Southern Illinois Family Medicine Corporation |
|---|---|
| Speciality | Family Medicine |
| Location | 104 Magnolia Dr Ste A, Glen Carbon, Illinois |
| Authorized Official Name and Position | Jim Hong (OWNER) |
| Authorized Official Contact | 6182889466 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southern Illinois Family Medicine Corporation 104 Magnolia Dr Ste A Glen Carbon IL 62034-1595 Ph: (618) 288-9466 | Southern Illinois Family Medicine Corporation 104 Magnolia Dr Ste A Glen Carbon IL 62034-1595 Ph: (618) 288-9466 |
| NPI Number | 1629086806 |
|---|---|
| Provider Enumeration Date | 08/04/2006 |
| Last Update Date | 02/01/2018 |
| Medicare PECOS PAC ID | 8628071172 |
|---|---|
| Medicare Enrollment ID | O20060823000090 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629086806 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 036114185 (Illinois) | Primary |
| Provider Name | Jim Jiantao Hong |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1487662656 PECOS PAC ID: 5597768044 Enrollment ID: I20060823000134 |
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