Siloam LLC

Primary specialty

Radiation Oncology PhysicianTaxonomy code 2085R0001X

Legal business name

SILOAM LLC

Doing business as

SOUTHERN ILLINOIS CANCER CENTER

Practice address

10286 Fleming Rd
Carterville, IL 62918-3351

Phone

(918) 985-4000

NPI assigned

May 24, 2006

Organization subpart

No

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

Authorized official

Name

Jack T Sandford, MD

Title

Owner

Phone

(618) 985-4000

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• SOUTHERN ILLINOIS CANCER CENTER Doing business as

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

{
    "created_epoch": "1148428800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1720033046",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "171 TECHNOLOGY DR",
            "address_2": "SUITE 200",
            "city": "BOALSBURG",
            "state": "PA",
            "postal_code": "168271530",
            "telephone_number": "814-237-8627",
            "fax_number": "814-238-0083"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10286 FLEMING RD",
            "city": "CARTERVILLE",
            "state": "IL",
            "postal_code": "629183351",
            "telephone_number": "918-985-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SILOAM LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-24",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "SANDFORD",
        "authorized_official_first_name": "JACK",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "618-985-4000",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2085R0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Radiation Oncology",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHLINK",
            "identifier": "455350",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IL BCBS",
            "identifier": "10027422",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036104428",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SOUTHERN ILLINOIS CANCER CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Radiation Oncology Physician in Carterville, IL
• Providers in Carterville, IL by specialty
• Radiation Oncology Physician 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.