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Southern Illinois Neurologic Institute
Specialist in Belleville, Illinois
NPI 1629190657

Southern Illinois Neurologic Institute is a Specialist based in Belleville, IL. Southern Illinois Neurologic Institute practices in Belleville, IL. The NPI Number for Southern Illinois Neurologic Institute is 1629190657 and holds a License No. 36078383 (Illinois).

The current practice location address for Southern Illinois Neurologic Institute is 100 N Jackson St, Belleville, IL and can be reached out via phone at 618-239-6660 and via fax at 618-239-6662.

Location: 100 N Jackson St, Belleville, IL, 62220-1427
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1629190657
Provider Name
Southern Illinois Neurologic Institute
Credential
Provider Entity Type
Organization
Address
100 N Jackson St, Belleville, IL, 62220-1427
Phone Number
618-239-6660
Fax Number
618-239-6662
Provider Enumeration Date
04/03/2007
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
130015602 01 IL RAILROAD MEDICARE
08207706 01 IL BLUE CROSS BLUE SHIELD
institution
Provider Business Practice Location Address Details
Address
100 N Jackson St
City
Belleville
State
Illinois
Zip
62220-1427
Phone Number
618-239-6660
Fax Number
618-239-6662
person
Provider Business Mailing Address Details
Address
100 N Jackson St
City
Belleville
State
Illinois
Zip
62220-1427
Phone Number
618-239-6660
Fax Number
618-239-6662
person
Provider's Taxonomy Details 1
Type
Other Service Providers
Classification
Specialist
Speciality
-
Taxonomy
174400000X
License No.
36078383 (Illinois)
Definition
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
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