Provider Demographics
NPI:1245442375
Name:SOUTHERN ILLINOIS HAND CENTER, SC
Entity type:Organization
Organization Name:SOUTHERN ILLINOIS HAND CENTER, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NASH
Authorized Official - Middle Name:
Authorized Official - Last Name:NAAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:217-347-3003
Mailing Address - Street 1:901 MEDICAL PARK DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:EFFINGHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62401
Mailing Address - Country:US
Mailing Address - Phone:217-347-3003
Mailing Address - Fax:217-347-3005
Practice Address - Street 1:901 MEDICAL PARK DRIVE
Practice Address - Street 2:SUITE 100
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401
Practice Address - Country:US
Practice Address - Phone:217-347-3003
Practice Address - Fax:217-347-3005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL360670472086S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the HandGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2500075OtherBCBS IL
DA0723OtherRAILROAD MEDICARE
568820Medicare PIN
2500075OtherBCBS IL
ILC41344Medicare UPIN