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Southern Illinois Psychiatry LLC

Organization Active NPI Psychiatry Physician · Marion, IL

NPI 1992988299 · NPPES record last updated Aug 4, 2009

Key facts

NPI
1992988299
Entity type
Organization (NPI type 2)
Primary specialty
Psychiatry Physician 2084P0800X
Legal business name
SOUTHERN ILLINOIS PSYCHIATRY LLC
Practice address
4503 W Deyoung St Ste C-103
Marion, IL 62959-0030
Phone
(618) 998-0888
Fax
(618) 993-1808
NPI assigned
Dec 10, 2007
Organization subpart
No

Authorized official

Name
Naeem A Qureshi
Title
President
Phone
(618) 998-0888

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

National Provider Directory

Locations

1257 E Walnut St
Ste 1
Carbondale, IL 62901
Phone (618) 351-9700

4503 W Deyoung St
Ste C103
Marion, IL 62959
Phone (618) 998-0888

112 Airway Dr
Marion, IL 62959
Phone (618) 988-0888

4503 W Deyoung St
#103C
Marion, IL 62959
Phone (618) 998-0888

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician
Group: 193400000X SINGLE SPECIALTY GROUP		 2084P0800X Yes

Addresses

Primary practice location

4503 W Deyoung St Ste C-103
Marion, IL 62959-0030

Mailing address

4503 W Deyoung St Ste C-103
Marion, IL 62959-0030
Phone (618) 998-0888

Other identifiers

IdentifierTypeStateIssuer
036094666MedicaidIL
207779OtherILMEDICARE

Other providers in Marion, IL

All providers in Marion, IL · Psychiatry Physician in Illinois

Sources for this page

Verify at the official NPI Registry.