Southern Illinois Gastroenterology LLC
Internal Medicine, Gastroenterology in Highland, IL. Organization (NPI-2).
NPI number1902467798
StatusActive
Last updated in NPPESJun 24, 2019
Details
- NPI
- 1902467798
- Entity type
- Organization (NPI-2)
- Legal business name
- Southern Illinois Gastroenterology LLC
- Organization subpart
- No
- Enumeration date
- Jun 24, 2019
- Last updated
- Jun 24, 2019
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207RG0100X | Internal Medicine, Gastroenterology | – | – | Yes |
Practice location
1212 BroadwayHighland, IL 62249-1960
Phone 618-391-5070 · Fax 618-288-1872
Mailing address
1212 BroadwayHighland, IL 62249-1960
Phone 618-391-5070 · Fax 618-288-1872
Authorized official
Edmundo A Rodriguez-Frias
Owner
6183915070
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