Provider Demographics
NPI:1992032809
Name:SOUTHERN ILLINOIS MEDICAL SERVICES, NFP
Entity Type:Organization
Organization Name:SOUTHERN ILLINOIS MEDICAL SERVICES, NFP
Other - Org Name:MEDICAL ARTS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:REX
Authorized Official - Middle Name:
Authorized Official - Last Name:BUDDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-457-5200
Mailing Address - Street 1:1239 E MAIN ST
Mailing Address - Street 2:P.O. BOX 3988
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62902-3988
Mailing Address - Country:US
Mailing Address - Phone:618-684-2172
Mailing Address - Fax:
Practice Address - Street 1:19 E SHAWNEE DR
Practice Address - Street 2:SUITE 2
Practice Address - City:MURPHYSBORO
Practice Address - State:IL
Practice Address - Zip Code:62966-7071
Practice Address - Country:US
Practice Address - Phone:618-684-2172
Practice Address - Fax:618-687-4480
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHERN ILLINOIS HOSPITAL SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-11-13
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL143871Medicare Oscar/Certification