Provider Demographics
NPI:1558385989
Name:SIU PHYSICIANS & SURGEONS, INC
Entity Type:Organization
Organization Name:SIU PHYSICIANS & SURGEONS, INC
Other - Org Name:SIU HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASST MGR, MEDICAL STAFF SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:SHELBY
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:BURDICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-545-6523
Mailing Address - Street 1:PO BOX 19639
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62794-9639
Mailing Address - Country:US
Mailing Address - Phone:217-545-8000
Mailing Address - Fax:844-470-2488
Practice Address - Street 1:201 E MADISON ST STE 328
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62702-5131
Practice Address - Country:US
Practice Address - Phone:217-545-8000
Practice Address - Fax:844-470-2488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207N00000X, 207ND0101X, 207Q00000X, 207R00000X, 207RE0101X, 207RG0100X, 2084P0800X, 208M00000X
207RA0201X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & ImmunologyGroup - Multi-Specialty
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
No207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001558385989Medicaid
ILCB2589OtherRR MEDICARE
ILCE8689OtherRR MEDICARE
ILCE8688OtherRR MEDICARE
ILCE8686OtherRR MEDICARE
ILCE8931OtherRR MEDICARE
ILCE8687OtherRR MEDICARE
ILCE8687OtherRR MEDICARE
ILCB2589OtherRR MEDICARE
IL256515Medicare PIN
IL256510Medicare PIN
IL256514Medicare PIN
IL256512Medicare PIN