Southern Illinois Gastroenterology LLC

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

Legal business name

SOUTHERN ILLINOIS GASTROENTEROLOGY LLC

Practice address

1212 Broadway
Highland, IL 62249-1960

Phone

(618) 391-5070

Fax

(618) 288-1872

NPI assigned

Jun 24, 2019

Organization subpart

No

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

Authorized official

Name

Edmundo A Rodriguez-Frias, MD

Title

Owner

Phone

(618) 391-5070

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1561334400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1561334400000",
    "number": "1902467798",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1212 BROADWAY",
            "city": "HIGHLAND",
            "state": "IL",
            "postal_code": "622491960",
            "telephone_number": "618-391-5070",
            "fax_number": "618-288-1872"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1212 BROADWAY",
            "city": "HIGHLAND",
            "state": "IL",
            "postal_code": "622491960",
            "telephone_number": "618-391-5070",
            "fax_number": "618-288-1872"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN ILLINOIS GASTROENTEROLOGY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-24",
        "last_updated": "2019-06-24",
        "status": "A",
        "authorized_official_last_name": "RODRIGUEZ-FRIAS",
        "authorized_official_first_name": "EDMUNDO",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "618-391-5070",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shivani Sharma, MD
• Chelsey Rachelle Short, M.S. CCC-SLP
• Emalee Shubert
• Donald E. Smith, CRNA
• Lauren Virginia Smith, PNP
• Southern Obstetric & Gyneco Associates
• St Josephs Hospital Breese of the Hospital Sisters of the Third Orde
• St Josephs Hospital of the Hospital Sisters of the Third Order of St F
• St Josephs Hospital of the Hospital Sisters of the Third Order of St F
• St Josephs Hospital of the Hospital Sisters of the Third Order of St F

• Gastroenterology Physician in Highland, IL
• Providers in Highland, 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 24, 2019; 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.