Southern Illinois Physician Services, PC

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

Legal business name

SOUTHERN ILLINOIS PHYSICIAN SERVICES, PC

Practice address

4600 Memorial Drive
Suite 340
Belleville, IL 62226

Phone

(618) 222-9999

Fax

(618) 222-9337

NPI assigned

Oct 9, 2006

Last updated

Jun 21, 2018By 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

Rebecca J Tiberend

Title

Billing Officer Supervisor

Phone

(618) 222-9999

Specialties & licenses 4

Addresses

Locations

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Warren J Fournier II, MD

  • Psychiatry Physician
  • Fairview Heights, IL
  • NPI 1992770580
  NPD (past)
• Carolyn K McMurphy-Quick, PA

  • Physician Assistant
  • Centralia, IL
  • NPI 1649226051
  NPD (past)
• Janet P. Rudderham, PA-C

  • Medical Physician Assistant
  • Belleville, IL
  • NPI 1366433286
  NPD (past)
• Brittany Wolf, PA-C

  • Physician Assistant
  • Belleville, IL
  • NPI 1760546261
  NPD (past)
• Rajen H Doshi, MD

  • Urology Physician
  • Festus, MO
  • NPI 1720060536
  NPD (past)
• Mohammad Tarik Alam Firozi, MD

  • Gastroenterology Physician
  • Saint Louis, MO
  • NPI 1962481648
  NPD (past)
• Edward Joseph Stanford, MD

  • Gynecology Physician
  • Manteca, CA
  • NPI 1326094715
  NPD (past)

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

{
    "created_epoch": "1160352000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529539200000",
    "number": "1508953746",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 23620",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622230620",
            "telephone_number": "618-222-9999",
            "fax_number": "618-222-9337"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4600 MEMORIAL DRIVE",
            "address_2": "SUITE 340",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "62226",
            "telephone_number": "618-222-9999",
            "fax_number": "618-222-9337"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN ILLINOIS PHYSICIAN SERVICES, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-09",
        "last_updated": "2018-06-21",
        "status": "A",
        "authorized_official_last_name": "TIBEREND",
        "authorized_official_first_name": "REBECCA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "BILLING OFFICER SUPERVISOR",
        "authorized_official_telephone_number": "618-222-9999"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207VG0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology, Gynecology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Urology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Southern Illinois Healthcare Foundation, Inc. (Children's Medical Center)
• Southern Illinois Internal Medicine LTD
• Southern Illinois Neurologic Institute
• Southern Illinois Oral & Maxillofacial Surgery, LTD.
• Southern Illinois Otolaryngology, LTD
• Southern Illinois Pulmonary Consultants, LTD.
• Southern Illinois Surgical Appliance Co (Sisa Home Medical)
• Southern Illinois Vascular Surgery, PC
• Southwestern Illinois College (Alternative Transportation System)
• Southwestern Illinois College Programs for Older Psreons

• Gastroenterology Physician in Belleville, IL
• Providers in Belleville, IL by specialty
• Gastroenterology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2018; 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.