Provider Demographics
NPI:1851327878
Name:SOUTHWEST ILLINOIS HEALTH SERVICES, LLP
Entity Type:Organization
Organization Name:SOUTHWEST ILLINOIS HEALTH SERVICES, LLP
Other - Org Name:CANCER TREATMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:GUSMANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:182-575-6076
Mailing Address - Street 1:4000 N ILLINOIS LN
Mailing Address - Street 2:SUITE B
Mailing Address - City:SWANSEA
Mailing Address - State:IL
Mailing Address - Zip Code:62226-1965
Mailing Address - Country:US
Mailing Address - Phone:618-236-1000
Mailing Address - Fax:618-236-1299
Practice Address - Street 1:4000 NORTH ILLINOIS
Practice Address - Street 2:SUITE B
Practice Address - City:SWANSEA
Practice Address - State:IL
Practice Address - Zip Code:62226-1946
Practice Address - Country:US
Practice Address - Phone:618-236-1000
Practice Address - Fax:618-236-1299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-23
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL767370Medicare ID - Type Unspecified