Provider Demographics
NPI:1558367177
Name:SOUTHERN ILLINOIS GERIATRICS, P.C.
Entity Type:Organization
Organization Name:SOUTHERN ILLINOIS GERIATRICS, P.C.
Other - Org Name:GERIATRICS FIRST, P.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:G
Authorized Official - Last Name:UHRIG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:618-526-7399
Mailing Address - Street 1:9409 HOLY CROSS LN
Mailing Address - Street 2:
Mailing Address - City:BREESE
Mailing Address - State:IL
Mailing Address - Zip Code:62230-3510
Mailing Address - Country:US
Mailing Address - Phone:618-526-7399
Mailing Address - Fax:618-526-7399
Practice Address - Street 1:9409 HOLY CROSS LN
Practice Address - Street 2:
Practice Address - City:BREESE
Practice Address - State:IL
Practice Address - Zip Code:62230-3510
Practice Address - Country:US
Practice Address - Phone:618-526-7399
Practice Address - Fax:618-526-7399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
K02927Medicare UPIN
207948Medicare ID - Type Unspecified