Provider Demographics
NPI:1003930629
Name:LINDA K. SIMONS
Entity Type:Organization
Organization Name:LINDA K. SIMONS
Other - Org Name:SILHOUETTE SHOPPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:K
Authorized Official - Last Name:SIMONS
Authorized Official - Suffix:
Authorized Official - Credentials:CFM
Authorized Official - Phone:217-223-8791
Mailing Address - Street 1:117 N 6TH ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301-2903
Mailing Address - Country:US
Mailing Address - Phone:217-223-8791
Mailing Address - Fax:217-223-8791
Practice Address - Street 1:117 N 6TH ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-2903
Practice Address - Country:US
Practice Address - Phone:217-223-8791
Practice Address - Fax:217-223-8791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
00132029OtherBLUE CROSS BLUE SHIELD
IL0387860001Medicare NSC