Provider Demographics
NPI:1588786339
Name:SOUTHERN ILLINOIS ONCOLOGY & HEMATOLOGY LTD
Entity type:Organization
Organization Name:SOUTHERN ILLINOIS ONCOLOGY & HEMATOLOGY LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:CUARTAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:618-993-1030
Mailing Address - Street 1:3008 CIVIC CIRCLE BLVD
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959-5262
Mailing Address - Country:US
Mailing Address - Phone:618-993-1030
Mailing Address - Fax:
Practice Address - Street 1:3008 CIVIC CIRCLE BLVD
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-5262
Practice Address - Country:US
Practice Address - Phone:607-324-2340
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036098622207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL10027291OtherBCBS OF ILLINOIS
IL036098622Medicaid
622690Medicare PIN
860007192Medicare PIN