Provider Demographics
NPI:1457454860
Name:HEALTH CENTERS OF SOUTHERN ILLINOIS SC.
Entity Type:Organization
Organization Name:HEALTH CENTERS OF SOUTHERN ILLINOIS SC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:LEON
Authorized Official - Last Name:MILLS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:618-687-2396
Mailing Address - Street 1:1012 N. 14TH ST
Mailing Address - Street 2:
Mailing Address - City:MURPHYSBORO
Mailing Address - State:IL
Mailing Address - Zip Code:62966-1600
Mailing Address - Country:US
Mailing Address - Phone:618-687-2396
Mailing Address - Fax:618-684-5870
Practice Address - Street 1:1012 N. 14TH ST
Practice Address - Street 2:
Practice Address - City:MURPHYSBORO
Practice Address - State:IL
Practice Address - Zip Code:62966-1600
Practice Address - Country:US
Practice Address - Phone:618-687-2396
Practice Address - Fax:618-684-5870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
111N00000X, 207Q00000X
ILD38.003742111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty