Provider Demographics
NPI:1326411927
Name:SOUTHERN ILLINOIS PHYSICIANS GROUP LTD
Entity Type:Organization
Organization Name:SOUTHERN ILLINOIS PHYSICIANS GROUP LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:THAYER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:618-789-0012
Mailing Address - Street 1:PO BOX 997
Mailing Address - Street 2:
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62025-0997
Mailing Address - Country:US
Mailing Address - Phone:618-692-6700
Mailing Address - Fax:618-692-6711
Practice Address - Street 1:203 E MAIN ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:IL
Practice Address - Zip Code:62246-1810
Practice Address - Country:US
Practice Address - Phone:618-692-6700
Practice Address - Fax:618-692-6711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-04
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty