NPIMap

Organization Active NPI

Southern Illinois Surgical Appliance Co.

  • Durable Medical Equipment & Medical Supplies
  • Carbondale, IL
National Provider Identifier
1720199748
Registry record updated Oct 25, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
License
2032-1120 Issued in IL
Legal business name
SOUTHERN ILLINOIS SURGICAL APPLIANCE CO.
Practice address
1301 W Main St
Carbondale, IL 62901-2227
Phone
(618) 529-2406
Fax
(618) 351-7466
NPI assigned
Aug 31, 2006
Organization subpart
Yes
Parent organization
SOUTHERN ILLINIOIS SURGICAL APPLIANCEAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 25, 2010

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

Authorized official

Name
Mr. Ralph Randolph Lewis
Title
President
Phone
(618) 932-3157

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 2032-1120 IL Primary
Customized Equipment (DME) 332BC3200X 2032-1120 IL
Oxygen Equipment & Supplies (DME) 332BX2000X 2032-1120 IL

Addresses

Primary practice location

1301 W Main St
Carbondale, IL 62901-2227

Mailing address

PO Box 1667
Mount Vernon, IL 62864-0033
Phone (618) 529-2406

Other names 1

  • SISA HOME MEDICAL Doing business as

National Provider Directory

National Provider Directory
Part of
Southern Ill Surg Appli

Locations

1301 W Main St
Carbondale, IL 62901
Phone (618) 529-2406

NPI Registry JSON

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1287964800000",
    "number": "1720199748",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1667",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628640033",
            "telephone_number": "618-529-2406",
            "fax_number": "618-351-7466"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 W MAIN ST",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629012227",
            "telephone_number": "618-529-2406",
            "fax_number": "618-351-7466"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN ILLINOIS SURGICAL APPLIANCE CO.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOUTHERN ILLINIOIS SURGICAL APPLIANCE",
        "enumeration_date": "2006-08-31",
        "last_updated": "2010-10-25",
        "status": "A",
        "authorized_official_last_name": "LEWIS",
        "authorized_official_first_name": "RALPH",
        "authorized_official_middle_name": "RANDOLPH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "618-932-3157",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "IL",
            "license": "2032-1120",
            "primary": true
        },
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": "IL",
            "license": "2032-1120",
            "primary": false
        },
        {
            "code": "332BX2000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies",
            "state": "IL",
            "license": "2032-1120",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SISA HOME MEDICAL",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Carbondale, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2010; 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.