SI03, INC. (NPI# 1144505447) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1144505447 |
| Entity Type | Organization |
| Organization Name | SI03, INC. |
| Practice Address |
4711 Nash Road Scott City MO 63780 |
| Mailing Address |
Po Box 1715 Cape Girardeau MO 63702 |
| Practice Telephone | 5733882301 |
| Practice Fax Number | 5733882308 |
| Mailing Telephone | 5733882301 |
| Mailing Fax Number | 5733882302 |
| Enumeration Date | 2011-10-18 |
| Last Update Date | 2011-10-18 |
| Authorized Official Name | MR. JEFF FANGER (GENERAL MANAGER) |
| Authorized Official Telephone | 5733882301 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 335G00000X | Medical Foods Supplier | Suppliers |
| Street Address |
4711 NASH ROAD |
| City | SCOTT CITY |
| State | MO |
| Zip Code | 63780 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215464193 | Ashton Elfrink | Occupational Therapy Assistant | 528 Co Hwy 210, Scott City, MO 63780 | 2017-05-22 |
| 1881013209 | Jessica Mier | Speech-Language Pathologist | 311 Steck St, Scott City, MO 63780-1105 | 2014-04-14 |
| 1205080538 | Scott City School District R-1 | Local Education Agency (LEA) | 3000 Main St, Scott City, MO 63780-1111 | 2008-11-13 |
| 1285877282 | Dianne Patricia Roth | Speech-Language Pathologist | 3000 Main St, Scott City, MO 63780-1111 | 2009-04-07 |
| 1326108382 | Teresa Jean Cobb | Occupational Therapist | 112 N Berkley St, Scott City, MO 63780-1202 | 2006-12-11 |
| 1386785277 | Cathy Wyatt | Physical Therapist | 112 N Berkley St, Scott City, MO 63780-1202 | 2007-02-12 |
| 1497896070 | Pediatric Therapy Unlimited Inc | Occupational Therapist | 112 N Berkley St, Scott City, MO 63780-1202 | 2007-02-08 |
| 1649397779 | Ron Mcculley | Clinic/Center | 2520 James St, Scott City, MO 63780-1219 | 2007-03-23 |
| 1598371593 | Scott City Sunshine LLC | Assisted Living Facility | 2520 James St, Scott City, MO 63780-1219 | 2020-09-16 |
| 1639554488 | Sunshine Villa Homes LLC | Assisted Living Facility | 2520 James St, Scott City, MO 63780-1219 | 2015-07-22 |
| Find all providers in zip 63780 | ||||
| Taxonomy Code | 335G00000X |
| Grouping | Suppliers |
| Classification | Medical Foods Supplier |
| A supplier of special replacement foods for clients with errors of metabolism that prohibit them from eating a regular diet. Medical foods are lacking in the compounds which cause complications of the metabolic disorder, and are not generally available in grocery stores, health food stores, or pharmacies. |
| Notes: Source: The Children with Special Healthcare Needs (CSHCN) Services Program, a program of the Texas Department of State Health Services |
| City | SCOTT CITY |
| Zip Code | 63780 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.