Provider Demographics
NPI:1093801797
Name:SOUTHERN ILLINOIS HOSPITAL SERVICES
Entity type:Organization
Organization Name:SOUTHERN ILLINOIS HOSPITAL SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CORPORATE DIRECTOR, PATIENT FINANCI
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:HARTKE
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, CHFP
Authorized Official - Phone:618-457-5200
Mailing Address - Street 1:1239 E. MAIN
Mailing Address - Street 2:PO BOX 3988
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62901-3988
Mailing Address - Country:US
Mailing Address - Phone:618-457-5200
Mailing Address - Fax:
Practice Address - Street 1:405 W JACKSON
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-1000
Practice Address - Country:US
Practice Address - Phone:618-457-5200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0000513282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0000513OtherSTATE OF IL LICENSE NUMBE
ILDE1812Medicare PIN
IL0000513OtherSTATE OF IL LICENSE NUMBE
IL813900Medicare ID - Type UnspecifiedMEDICARE PART B PROVIDER
IL813990Medicare PIN
IL140164Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
IL203944Medicare PIN