NPIMap

Organization Active NPI

Kidney Care Services of Southern Illinois, LTD

  • Medical Specialty Clinic/Center
  • Du Quoin, IL
National Provider Identifier
1669501912
Registry record updated Aug 12, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Specialty Clinic/CenterTaxonomy code 261QM2500X
License
036102569 Issued in IL
Legal business name
KIDNEY CARE SERVICES OF SOUTHERN ILLINOIS, LTD
Practice address
900 N Washington St
Du Quoin, IL 62832-1230
Phone
(618) 542-3048
Fax
(618) 542-3097
NPI assigned
Mar 5, 2007
Last updated
Aug 12, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 12, 2008

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

Authorized official

Name
Dr. Mohammad S Shafi, MC
Title
Owner
Phone
(618) 542-3048

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Specialty Clinic/Center 261QM2500X 036102569 IL Primary

Addresses

Primary practice location

900 N Washington St
Du Quoin, IL 62832-1230

Mailing address

PO Box 181
Du Quoin, IL 62832-0181
Phone (618) 542-3048

Other identifiers 1

IdentifierTypeStateIssuer
036102569MedicaidIL

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1173052800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1218499200000",
    "number": "1669501912",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 181",
            "city": "DU QUOIN",
            "state": "IL",
            "postal_code": "628320181",
            "telephone_number": "618-542-3048",
            "fax_number": "618-542-3097"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 N WASHINGTON ST",
            "city": "DU QUOIN",
            "state": "IL",
            "postal_code": "628321230",
            "telephone_number": "618-542-3048",
            "fax_number": "618-542-3097"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIDNEY CARE SERVICES OF SOUTHERN ILLINOIS, LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-05",
        "last_updated": "2008-08-12",
        "status": "A",
        "authorized_official_last_name": "SHAFI",
        "authorized_official_first_name": "MOHAMMAD",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "618-542-3048",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MC"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "IL",
            "license": "036102569",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036102569",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Du Quoin, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 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.