Provider Demographics
NPI:1356435135
Name:SOUTHERN ILLINOIS HOSPITAL SERVICES
Entity type:Organization
Organization Name:SOUTHERN ILLINOIS HOSPITAL SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CORPORATE DIRECTOR, PATIENT FINANCI
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:HARTKE
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, CHPP
Authorized Official - Phone:618-457-5200
Mailing Address - Street 1:1239 E. MAIN
Mailing Address - Street 2:PO BOX 3988
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62901-3988
Mailing Address - Country:US
Mailing Address - Phone:618-457-5200
Mailing Address - Fax:
Practice Address - Street 1:2 SOUTH HOSPITAL DRIVE
Practice Address - Street 2:
Practice Address - City:MURPHYSBORO
Practice Address - State:IL
Practice Address - Zip Code:62966
Practice Address - Country:US
Practice Address - Phone:618-684-3156
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL004614282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
CB8501Medicare PIN
IL203243Medicare PIN
IL205052Medicare PIN
IL141334Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
IL203944Medicare ID - Type UnspecifiedMEDICARE PART B NUMBER
IL613930Medicare ID - Type UnspecifiedMEDICARE PART B PROVIDER