Provider Demographics
NPI:1346348364
Name:SOUTHERN ILLINOIS HEMATOLOGY ONCOLOGY LTD
Entity Type:Organization
Organization Name:SOUTHERN ILLINOIS HEMATOLOGY ONCOLOGY LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:FALOUDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-942-8822
Mailing Address - Street 1:220 S PARK AVE
Mailing Address - Street 2:PO BOX 667
Mailing Address - City:HERRIN
Mailing Address - State:IL
Mailing Address - Zip Code:62948-3612
Mailing Address - Country:US
Mailing Address - Phone:618-942-8822
Mailing Address - Fax:618-942-4477
Practice Address - Street 1:220 S PARK AVE
Practice Address - Street 2:
Practice Address - City:HERRIN
Practice Address - State:IL
Practice Address - Zip Code:62948-3612
Practice Address - Country:US
Practice Address - Phone:618-942-8822
Practice Address - Fax:618-942-4477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========OtherTAX ID