Southern Illinois Center for Health

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

SOUTHERN ILLINOIS CENTER FOR HEALTH

Practice address

509 Hamacher St
Waterloo, IL 62298-1592

Phone

(618) 939-3939

Fax

(618) 939-3941

NPI assigned

Dec 15, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Judy Rebholz

Title

Office Manager

Phone

(618) 939-3939

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166140800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1104988971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "509 HAMACHER ST",
            "city": "WATERLOO",
            "state": "IL",
            "postal_code": "622981592",
            "telephone_number": "618-939-3939",
            "fax_number": "618-939-3941"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "509 HAMACHER ST",
            "city": "WATERLOO",
            "state": "IL",
            "postal_code": "622981592",
            "telephone_number": "618-939-3939",
            "fax_number": "618-939-3941"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN ILLINOIS CENTER FOR HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-15",
        "last_updated": "2008-04-20",
        "status": "A",
        "authorized_official_last_name": "REBHOLZ",
        "authorized_official_first_name": "JUDY",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "618-939-3939"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelsie Lynnn Smith, MHP
• Lesley Smith, RSA
• Marla Rae Smith
• Maryem Smith
• Laura E Sorbel Beabout, DMD
• Southern Illinois Healthcare Foundation Inc
• Southern Illinois Imaging Associates, LLC
• Dylan Jacob Spencer, RSA
• St Anthony'S Physician Organization of Illinois
• St Louis Sinus & Sleep Centers, LLC

• Family Medicine Physician in Waterloo, IL
• Providers in Waterloo, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.