Provider Demographics
NPI:1396723458
Name:THORACIC CONSULTANTS OF SOUTHERN ILLINOIS, PC
Entity type:Organization
Organization Name:THORACIC CONSULTANTS OF SOUTHERN ILLINOIS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ORLANDO
Authorized Official - Middle Name:I
Authorized Official - Last Name:RUIZ-RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:618-462-9660
Mailing Address - Street 1:2 MEMORIAL DR
Mailing Address - Street 2:SUITE 204
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-6723
Mailing Address - Country:US
Mailing Address - Phone:618-462-9660
Mailing Address - Fax:618-462-9637
Practice Address - Street 1:2 MEMORIAL DR
Practice Address - Street 2:SUITE 204
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-6723
Practice Address - Country:US
Practice Address - Phone:618-462-9660
Practice Address - Fax:618-462-9637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-08
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL1613Medicare PIN