Si03, Inc.

Primary specialty

Medical Foods SupplierTaxonomy code 335G00000X

Legal business name

SI03, INC.

Practice address

4711 Nash Road
Scott City, MO 63780

Phone

(573) 388-2301

Fax

(573) 388-2308

NPI assigned

Oct 18, 2011

Last updated

Oct 18, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Jeff Fanger

Title

General Manager

Phone

(573) 388-2301

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1318896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1318896000000",
    "number": "1144505447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1715",
            "city": "CAPE GIRARDEAU",
            "state": "MO",
            "postal_code": "63702",
            "telephone_number": "573-388-2301",
            "fax_number": "573-388-2302"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4711 NASH ROAD",
            "city": "SCOTT CITY",
            "state": "MO",
            "postal_code": "63780",
            "telephone_number": "573-388-2301",
            "fax_number": "573-388-2308"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SI03, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-18",
        "last_updated": "2011-10-18",
        "status": "A",
        "authorized_official_last_name": "FANGER",
        "authorized_official_first_name": "JEFF",
        "authorized_official_title_or_position": "GENERAL MANAGER",
        "authorized_official_telephone_number": "573-388-2301",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "335G00000X",
            "taxonomy_group": "",
            "desc": "Medical Foods Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Medical Foods Supplier in Scott City, MO
• Providers in Scott City, MO by specialty
• Medical Foods Supplier in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2011; 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.