NPIMap

Organization Active NPI

Southern Illinois Neurologic Institute

  • Specialist
  • Belleville, IL
National Provider Identifier
1629190657
Registry record updated Jul 2, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
36078383 Issued in IL
Legal business name
SOUTHERN ILLINOIS NEUROLOGIC INSTITUTE
Practice address
100 N Jackson St
Belleville, IL 62220-1427
Phone
(618) 239-6660
Fax
(618) 239-6662
NPI assigned
Apr 3, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 2, 2008

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

Authorized official

Name
Dr. Guy Timothy Burrows, M.D.NPI 1821075060
Title
Owner
Phone
(618) 239-6660

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X 36078383 IL Primary

Addresses

Primary practice location

100 N Jackson St
Belleville, IL 62220-1427

Mailing address

100 N Jackson St
Belleville, IL 62220-1427
Phone (618) 239-6660

Other identifiers 2

IdentifierTypeStateIssuer
130015602OtherILRAILROAD MEDICARE
08207706OtherILBLUE CROSS BLUE SHIELD

National Provider Directory

National Provider Directory

Locations

100 N Jackson St
Belleville, IL 62220
Phone (618) 239-6660

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1175558400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214956800000",
    "number": "1629190657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 N JACKSON ST",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622201427",
            "telephone_number": "618-239-6660",
            "fax_number": "618-239-6662"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 N JACKSON ST",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622201427",
            "telephone_number": "618-239-6660",
            "fax_number": "618-239-6662"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN ILLINOIS NEUROLOGIC INSTITUTE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-03",
        "last_updated": "2008-07-02",
        "status": "A",
        "authorized_official_last_name": "BURROWS",
        "authorized_official_first_name": "GUY",
        "authorized_official_middle_name": "TIMOTHY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "618-239-6660",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "IL",
            "license": "36078383",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "130015602",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "08207706",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Belleville, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 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.