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SOUTHERN OBSTETRIC & GYNECO ASSOCIATES NPI 1881958981


NPI Information

NPI: 1881958981
Provider Name: SOUTHERN OBSTETRIC & GYNECO ASSOCIATES

Doing Business As: SOUTHERN OB/GYN

Classification: Obstetrics & Gynecology - 207V00000X
Entity Type: Organization

CLIA Number: 14D0434204

Address:
1201 RICKER RD
SALEM, IL
ZIP 62881
Phone: (618) 526-2209
Get Directions

SOUTHERN OBSTETRIC & GYNECO ASSOCIATES is an obstetrics gynecology in Salem, IL. The provider is an obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women. SOUTHERN OBSTETRIC & GYNECO ASSOCIATES NPI is 1881958981. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Southern Ob/gyn.

The provider's business location address is:

1201 RICKER RD
SALEM, IL
ZIP 62881-263
Phone: (618) 526-2209
Fax: (618) 526-7372

The provider's authorized official is Anne E Doll-pollard .
The authorized official title is President and has the following contact phone number (618) 526-2209.

The CLIA number assigned to this NPI record is 14D0434204 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 7/3/2012 and was last updated on 7/3/2012.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207V00000XObstetrics & Gynecology042005236ILLINOISYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1042005236OTHERILLINOISCOPORATE LICENSE
20994340001MEDICARE NSCILLINOIS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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