Provider Demographics
NPI:1013351667
Name:SOUTHERN ILLINOIS MEDICAL SPECIALISTS, LLC
Entity Type:Organization
Organization Name:SOUTHERN ILLINOIS MEDICAL SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/SOLE MEMBER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:BEE
Authorized Official - Suffix:
Authorized Official - Credentials:DO, FACOI
Authorized Official - Phone:618-625-2105
Mailing Address - Street 1:107 W FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:SESSER
Mailing Address - State:IL
Mailing Address - Zip Code:62884-1456
Mailing Address - Country:US
Mailing Address - Phone:618-625-2105
Mailing Address - Fax:618-625-2108
Practice Address - Street 1:107 W FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:SESSER
Practice Address - State:IL
Practice Address - Zip Code:62884-1456
Practice Address - Country:US
Practice Address - Phone:618-625-2105
Practice Address - Fax:618-625-2108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-25
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.125672207P00000X, 207R00000X, 207RH0002X, 207RS0012X, 208VP0014X
OH034.009566207P00000X, 207R00000X
OK4273207P00000X, 207R00000X
MO2012021377207P00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative MedicineGroup - Multi-Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036125672Medicaid
OKI44871Medicare UPIN