Provider Demographics
NPI:1003950395
Name:NEUROLOGY OF SOUTHERN ILLINOIS, LTD.
Entity Type:Organization
Organization Name:NEUROLOGY OF SOUTHERN ILLINOIS, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:LORI
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GUYTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:618-993-0444
Mailing Address - Street 1:3301 LOGAN DR
Mailing Address - Street 2:
Mailing Address - City:HERRIN
Mailing Address - State:IL
Mailing Address - Zip Code:62948-3732
Mailing Address - Country:US
Mailing Address - Phone:618-993-0444
Mailing Address - Fax:618-998-9302
Practice Address - Street 1:3301 LOGAN DR
Practice Address - Street 2:
Practice Address - City:HERRIN
Practice Address - State:IL
Practice Address - Zip Code:62948-3732
Practice Address - Country:US
Practice Address - Phone:618-993-0444
Practice Address - Fax:618-998-9302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL10008620OtherBLUE CROSS BLUE SHIELD
ILY15255Medicare UPIN
IL10008620OtherBLUE CROSS BLUE SHIELD