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Contact Information

SOUTHERN ILLINOIS MEDICAL SPECIALISTS, LLC
107 W FRANKLIN ST
SESSER, IL62884-1456
 Phone: 618-625-2105
 Fax: 618-625-2108
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Internal Medicine

207R00000X 11 Physician/Internal Medicine
 

Clinical Medical Laboratory

291U00000X 69 Clinical Laboratory
 

Independent Medical Examiner

202C00000X
 

Interventional Pain Medicine

208VP0014X 09 Physician/Interventional Pain Management
 

Neuromusculoskeletal Medicine & OMM

204D00000X 12 Physician/Osteopathic Manipulative Medicine
 

Primary Care

261QP2300X
Indicates primary specialty

NPI Profile & details for SOUTHERN ILLINOIS MEDICAL SPECIALISTS LLC · (Female)

NPI # 1134530173
Status Active
Credentials
Entity Individual
Enumeration date 05/13/2014
Last updated 05/13/2014 - About 12 years ago
Sole proprietor 1 Not specified
Identifiers
  • IL License # 036125672
  • IL License # 14D2034829
  • IL Medicaid 036125672
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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