Siu Physicians & Surgeons, Inc.

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

SIU PHYSICIANS & SURGEONS, INC.

Practice address

305 W Jackson St
Suite 200
Carbondale, IL 62901-1474

Phone

(618) 453-3777

Fax

(618) 453-1102

NPI assigned

Dec 5, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Nelson C Weichold

Title

Cfo

Phone

(217) 545-7578

Specialties & licenses 1

Addresses

Other names 1

• SOUTHERN ILLINOIS FAMILY MEDICINE Doing business as

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Rural health clinic certification: CCN 148995

Legal name

SIU CARE-A-VAN

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

Oct 31, 2007

Last certification

Apr 3, 2019

Ownership / control type

For profit – corporation

Facility address

305 West Jackson Street, Suite 200
Carbondale, IL 62901

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Siu Physicians & Surgeons, Inc

  • Community/Retail Pharmacy
  • Springfield, IL
  • NPI 1871882787

  Member Of

  NPD member

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

{
    "created_epoch": "1165276800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1508924093",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19639",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627949639",
            "telephone_number": "217-545-7578",
            "fax_number": "217-545-1884"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "305 W JACKSON ST",
            "address_2": "SUITE 200",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629011474",
            "telephone_number": "618-453-3777",
            "fax_number": "618-453-1102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SIU PHYSICIANS & SURGEONS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-05",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "WEICHOLD",
        "authorized_official_first_name": "NELSON",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "217-545-7578",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SOUTHERN ILLINOIS FAMILY MEDICINE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Rosemary Elizabeth Simmons, PH.D.
• James E Simpson, D.M.D
• Kelsi Simpson
• Megan E Sims, DNP, CRNA
• Jai P. Singh, MD
• Kenneth Cole Sizemore
• Deimani Skerrett
• Sleep Wellness Equipment & Supplies, LLC
• Sharon A Smaga, M.D.
• Smichael Vancil DMD LLC

• Rural Health Clinic/Center in Carbondale, IL
• Providers in Carbondale, IL by specialty
• Rural Health Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.