Provider Demographics
NPI:1225122047
Name:SOUTHERN ILLINOIS HOSPITAL SERVICES
Entity Type:Organization
Organization Name:SOUTHERN ILLINOIS HOSPITAL SERVICES
Other - Org Name:HERRIN HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CORPORATE DIRECTOR, PATIENT FINANCI
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:HARTKE
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, CHFP
Authorized Official - Phone:618-457-5200
Mailing Address - Street 1:1239 E. MAIN
Mailing Address - Street 2:PO BOX 3988
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62901-3988
Mailing Address - Country:US
Mailing Address - Phone:618-457-5200
Mailing Address - Fax:
Practice Address - Street 1:201 S. 14TH
Practice Address - Street 2:
Practice Address - City:HERRIN
Practice Address - State:IL
Practice Address - Zip Code:62948
Practice Address - Country:US
Practice Address - Phone:618-942-2171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0000935273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL14T011Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
ILCA3539Medicare PIN
IL205799Medicare PIN
ILDE4303Medicare PIN
IL203944Medicare PIN
IL820270Medicare PIN