SOUTHERN ILLINOIS MEDICAL SERVICES NFP NPI 1982845137

NPI Information

NPI: 1982845137
Provider Name: SOUTHERN ILLINOIS MEDICAL SERVICES, NFP

Doing Business As: BENTON COMMUNITY HEALTHCARE

Classification: Clinic/Center - 261QR1300X
Entity Type: Organization

Specialization: Rural Health

Address:
203 BAILEY LN
BENTON, IL
ZIP 62812
Phone: (618) 438-5670
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SOUTHERN ILLINOIS MEDICAL SERVICES, NFP is a rural health clinic center in Benton, IL. SOUTHERN ILLINOIS MEDICAL SERVICES, NFP NPI is 1982845137. The provider is registered as an organization entity type.
The provider Is Doing Business As Benton Community Healthcare.

The provider's business location address is:

203 BAILEY LN
BENTON, IL
ZIP 62812-969
Phone: (618) 438-5670
Fax: (618) 438-5709

The provider's authorized official is Rex P Budde .
The authorized official title is Chief Executive Officer and has the following contact phone number (618) 457-5200.

The CLIA number assigned to this NPI record is 14D1049047 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 3/18/2009 and was last updated on 3/18/2009.

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
1	261QR1300X	Clinic/Center	Rural Health			Yes

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
1	148942	MEDICARE OSCAR/CERTIFICATION	ILLINOIS
2	XXXXXXXXX002	MEDICAID	ILLINOIS

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

NPI Synchronization or Removal

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