Provider Demographics
NPI:1811954944
Name:SOUTHERN ILLINOIS SLEEP INSTITUTE
Entity type:Organization
Organization Name:SOUTHERN ILLINOIS SLEEP INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:G
Authorized Official - Last Name:HOPKIN
Authorized Official - Suffix:
Authorized Official - Credentials:RPSGT
Authorized Official - Phone:314-645-5855
Mailing Address - Street 1:PO BOX 797090
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63179-7000
Mailing Address - Country:US
Mailing Address - Phone:314-645-5855
Mailing Address - Fax:314-645-6446
Practice Address - Street 1:105 AIRWAY DR
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-5872
Practice Address - Country:US
Practice Address - Phone:618-997-5500
Practice Address - Fax:618-997-5501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-01
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0010032043OtherBLUE CROSS PROVIDER #
IL212587Medicare PIN