Provider Demographics
NPI:1215529367
Name:CIMA, CONNOR R
Entity type:Individual
Prefix:MR
First Name:CONNOR
Middle Name:R
Last Name:CIMA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 S CARBON ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959-1318
Mailing Address - Country:US
Mailing Address - Phone:270-564-5354
Mailing Address - Fax:
Practice Address - Street 1:6 EAGLE CTR STE 1
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-1945
Practice Address - Country:US
Practice Address - Phone:618-206-8816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-10
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL317957959Medicaid