SOUTHERN ILLINOIS MEDICAL SERVICES, NFP (NPI# 1215204938) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1215204938 |
| Entity Type | Organization |
| Organization Name | SOUTHERN ILLINOIS MEDICAL SERVICES, NFP |
| Other Organization Name | LOGAN PRIMARY CARE SERVICE |
| Practice Address |
502 W St Louis West Frankfort IL 62896-1968 |
| Mailing Address |
405 Rushing Dr Herrin IL 62948-3730 |
| Practice Telephone | 6189973400 |
| Practice Fax Number | 6189323797 |
| Mailing Telephone | 6189933300 |
| Mailing Fax Number | 6189976626 |
| Enumeration Date | 2011-11-23 |
| Last Update Date | 2011-11-23 |
| Authorized Official Name | REX P BUDDE (CEO/PRESIDENT) |
| Authorized Official Telephone | 6184575200 |
| Is Organization Subpart | Y |
| Parent Organization Name | SOUTHERN ILLINOIS HOSPITAL SERVICES |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QR1300X |
Clinic/Center Specialization: Rural Health |
IL | Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Logan Primary Care Service | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841614633 | Southern Illinois Medical Services, Nfp | Clinic/Center | 7211 Us 45 S Ste C, Carrier Mills, IL 62917-1305 | 2014-02-13 |
| 1538689062 | Southern Illinois Medical Services, Nfp | Clinic/Center | 98 Peach Ridge Rd, Anna, IL 62906-2243 | 2017-06-26 |
| 1750705364 | Southern Illinois Medical Services, Nfp | Clinic/Center | 117 E Clark St, Harrisburg, IL 62946-2702 | 2014-02-18 |
| 1477820900 | Southern Illinois Medical Services, Nfp | Clinic/Center | 405 Rushing Dr, Herrin, IL 62948-3730 | 2011-11-29 |
| 1780985135 | Southern Illinois Medical Services, Nfp | Clinic/Center | 203 Bailey Ln, Suite 1, Benton, IL 62812-1969 | 2010-11-16 |
| 1992032809 | Southern Illinois Medical Services, Nfp | Clinic/Center | 19 E Shawnee Dr, Suite 2, Murphysboro, IL 62966-7071 | 2009-11-13 |
| 1982845137 | Southern Illinois Medical Services, Nfp | Clinic/Center | 203 Bailey Ln, Benton, IL 62812-1969 | 2009-03-18 |
| 1154510808 | Southern Illinois Medical Services, Nfp | Clinic/Center | 2601 W Main St, Carbondale, IL 62901-1031 | 2007-10-18 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | SOUTHERN ILLINOIS MEDICAL SERVICES, NFP | 2601 W Main St, Carbondale, IL 62901-1031 |
| Street Address |
502 W ST LOUIS |
| City | WEST FRANKFORT |
| State | IL |
| Zip Code | 62896-1968 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023123346 | Logan Primary Care Service Corp. | Clinic/Center | 502 W St Louis, West Frankfort, IL 62896 | 2006-08-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417468406 | Desrie Dawn Farley | Psychologist | 508 East Main, West Frankfort, IL 62896 | 2017-10-17 |
| 1205346657 | Erin Hutchinson | Speech-Language Pathologist | 1401 W Sixth St, West Frankfort, IL 62896 | 2017-10-11 |
| 1326499740 | Casey Huff | Counselor | 202 South Bentley St, Marion, IL 62896 | 2016-06-27 |
| 1629321922 | Sage Psychiatry LLC | Psychiatry & Neurology | 410 W St Louis Street, West Frankfort, IL 62896 | 2012-10-24 |
| 1497907737 | Angela H Henson | Physician Assistant | 310 West St. Louis Street, West Frankfort, IL 62896 | 2008-10-17 |
| 1881884187 | Homestead House | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 905 North Jefferson, West Frankfort, IL 62896 | 2007-08-01 |
| 1528266608 | Christopher Greater Area Rural Health Planning Corp | Family Medicine | 502 West St Louis Street, West Frankfort Community Health Center, West Frankfort, IL 62896 | 2007-07-10 |
| 1437212016 | National Assistance Bureau, Inc. | Skilled Nursing Facility | Westside Care Center, 601 North Columbia St, West Frankfort, IL 62896 | 2006-12-18 |
| 1922176171 | Sebastian John Pagano | Dentist | 208 North Ida, West Frankfort, IL 62896 | 2006-12-04 |
| 1326152356 | Christopher S Shadowens | Physician Assistant | 502 St Louis Street, West Frankfort, IL 62896 | 2006-08-18 |
| Find all providers in zip 62896 | ||||
| Taxonomy Code | 261QR1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rural Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821561895 | Heartland Women's Healthcare Ltd | Clinic/Center | 215 N Logan St Ste A, West Frankfort, IL 62896-2314 | 2019-01-02 |
| 1285806422 | Stacy Gardner | Clinic/Center | 410 W Saint Louis St, West Frankfort, IL 62896-1956 | 2008-03-27 |
| 1023123346 | Logan Primary Care Service Corp. | Clinic/Center | 502 W St Louis, West Frankfort, IL 62896 | 2006-08-19 |
| 1548258437 | Health Plan of Southern Illinois, Inc. | Clinic/Center | 309 W Saint Louis St, West Frankfort, IL 62896-2099 | 2005-10-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396386181 | Board of Trustees of Southern Illinois University | Clinic/Center | 300 W Oak St Ste 100, Carbondale, IL 62901-1496 | 2019-10-02 |
| 1043872781 | Mendota Community Hospital | Clinic/Center | 1401 E 12th St Ste 400, Mendota, IL 61342-9216 | 2019-07-02 |
| 1114582913 | Hammond Henry Dist Hospital | Clinic/Center | 203 W Front St, Annawan, IL 61234-7756 | 2019-05-07 |
| 1841763810 | Heartland Women's Healthcare Ltd | Clinic/Center | 24 Veterans Dr, Harrisburg, IL 62946-3320 | 2019-01-02 |
| 1578040275 | Osf Healthcare System | Clinic/Center | 230 S Exchange St, Galva, IL 61434-1871 | 2018-07-25 |
| 1700380219 | Toofan Medical Holdings, Ltd. | Clinic/Center | 1510 W Springfield Rd Ste A, Taylorville, IL 62568-2764 | 2018-03-20 |
| 1326542903 | Toofan Medical Holdings, Ltd. | Clinic/Center | 1001 Avenue of Mid America Ste 4, Effingham, IL 62401-4634 | 2018-03-20 |
| 1649795659 | Harrisburg Medical Center Inc | Clinic/Center | 3106 Outer Dr Ste 200, Marion, IL 62959-5270 | 2017-08-10 |
| 1588186308 | Wabash General Hospital District | Clinic/Center | 1430 College Dr Ste A, Mount Carmel, IL 62863-2649 | 2017-07-13 |
| 1356884993 | Gibson Community Hospital Association | Clinic/Center | 510 Prairie Ln Unit B, Cissna Park, IL 60924-9710 | 2016-11-30 |
| Find all providers with the same taxonomy | ||||
| City | WEST FRANKFORT |
| Zip Code | 62896 |
Please comment or provide details below to improve the information on SOUTHERN ILLINOIS MEDICAL SERVICES, NFP.
| 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.