NPIMap

Organization Active NPI

Southern Illinois Medical Services, NFP

Doing business as Benton Community Healthcare

  • Rural Health Clinic/Center
  • Benton, IL
National Provider Identifier
1982845137
Registry record updated Mar 18, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
SOUTHERN ILLINOIS MEDICAL SERVICES, NFP
Doing business as
Benton Community Healthcare
Practice address
203 Bailey LN
Benton, IL 62812-1969
Phone
(618) 438-5670
Fax
(618) 438-5709
NPI assigned
Mar 18, 2009
Last updated
Mar 18, 2009By the provider in NPPES
Organization subpart
Yes
Parent organization
SOUTHERN ILLINOIS HOSPITAL SERVICESAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 18, 2009

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

Authorized official

Name
Mr. Rex P Budde
Title
Chief Executive Officer
Phone
(618) 457-5200

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

203 Bailey LN
Benton, IL 62812-1969

Mailing address

203 Bailey LN
Benton, IL 62812-1969
Phone (618) 438-5670

Other identifiers 1

IdentifierTypeStateIssuer
XXXXXXXXX002MedicaidIL

Other names 1

  • Benton Community Healthcare Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Benton Community Healthcare7 organizations share this tax ID, including this one
Part of
Memorial Hospital of Carbondale

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1237334400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1237334400000",
    "number": "1982845137",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "203 BAILEY LN",
            "city": "BENTON",
            "state": "IL",
            "postal_code": "628121969",
            "telephone_number": "618-438-5670",
            "fax_number": "618-438-5709"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "203 BAILEY LN",
            "city": "BENTON",
            "state": "IL",
            "postal_code": "628121969",
            "telephone_number": "618-438-5670",
            "fax_number": "618-438-5709"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN ILLINOIS MEDICAL SERVICES, NFP",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOUTHERN ILLINOIS HOSPITAL SERVICES",
        "enumeration_date": "2009-03-18",
        "last_updated": "2009-03-18",
        "status": "A",
        "authorized_official_last_name": "BUDDE",
        "authorized_official_first_name": "REX",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "618-457-5200",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "XXXXXXXXX002",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Benton Community Healthcare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Benton, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2009; 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.