Provider Demographics
NPI:1881401941
Name:SOUTHERN ILLINOIS EMERGENCY MEDICAL SERVICES
Entity type:Organization
Organization Name:SOUTHERN ILLINOIS EMERGENCY MEDICAL SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-340-1179
Mailing Address - Street 1:121 N 8TH ST
Mailing Address - Street 2:
Mailing Address - City:DUPO
Mailing Address - State:IL
Mailing Address - Zip Code:62239-1514
Mailing Address - Country:US
Mailing Address - Phone:618-340-1179
Mailing Address - Fax:580-628-2267
Practice Address - Street 1:1003 W CHERRY ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-1913
Practice Address - Country:US
Practice Address - Phone:618-340-1179
Practice Address - Fax:580-628-2267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-12
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport