| Southern Illinois Gi Specialists Llc | |
|
1100 W Diann Ln Carbondale IL 62901-5339 | |
| (618) 549-8006 | |
| (618) 549-8434 |
| Full Name | Southern Illinois Gi Specialists Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 1100 W Diann Ln, Carbondale, Illinois |
| Authorized Official Name and Position | Zahoor A Makhdoom (MD OWNER) |
| Authorized Official Contact | 6185498006 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southern Illinois Gi Specialists Llc Po Box 365 Carbondale IL 62903-0365 Ph: (618) 476-9399 | Southern Illinois Gi Specialists Llc 1100 W Diann Ln Carbondale IL 62901-5339 Ph: (618) 549-8006 |
| NPI Number | 1093775405 |
|---|---|
| Provider Enumeration Date | 03/28/2006 |
| Last Update Date | 08/12/2008 |
| Medicare PECOS PAC ID | 1658337456 |
|---|---|
| Medicare Enrollment ID | O20041203000280 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093775405 | NPI | - | NPPES |
| 063398 | Other | HEALTH ALLIANCE HMO | |
| 036094155 | Medicaid | IL | |
| 03926864 | Other | IL | BCBS IL |
| 435384 | Other | HEALTHLINK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | 036094155 (Illinois) | Primary |
| Provider Name | Moses O Adeyanju |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1306820121 PECOS PAC ID: 7012995137 Enrollment ID: I20040713001297 |
| Provider Name | Ellen M Chapman Pogue |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114996642 PECOS PAC ID: 6002879970 Enrollment ID: I20041111000105 |
| Provider Name | Zahoor Ahmed Makhdoom |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1982667309 PECOS PAC ID: 0840256673 Enrollment ID: I20041216000555 |
| Provider Name | Douglas C Brown |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1033364674 PECOS PAC ID: 5496941353 Enrollment ID: I20101118000510 |
| Provider Name | Alisa D Morgan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427456961 PECOS PAC ID: 7315265352 Enrollment ID: I20150423000612 |
| Provider Name | Andrea S Baldwin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063800944 PECOS PAC ID: 4284941063 Enrollment ID: I20150910001735 |
| Provider Name | Tashia I Fox |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467808584 PECOS PAC ID: 7315239662 Enrollment ID: I20160707001592 |
| Provider Name | Ariele N Lynch |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407366123 PECOS PAC ID: 7517228166 Enrollment ID: I20180223000164 |
| Provider Name | Megan M Zimmerman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740795194 PECOS PAC ID: 1658632153 Enrollment ID: I20180226000506 |
| Provider Name | Amanda Wilderman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659915171 PECOS PAC ID: 2668896390 Enrollment ID: I20200728000888 |
| Provider Name | Amy J Glasco |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689241309 PECOS PAC ID: 0941692792 Enrollment ID: I20220127002982 |
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