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Organization
SOUTHERN ILLINOIS FOOT AND ANKLE CLINIC LTD
Active
Organization
SOUTHERN ILLINOIS FOOT AND ANKLE CLINIC LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TAMI HEFNER (MEDICAL BILLER)
(618) 457-0431
Entity
Organization
Contact information
Practice address
1235 CEDAR CT, CARBONDALE, IL 62901-5335
(618) 457-0431
(618) 457-5199
Mailing address
PO BOX 997, CARBONDALE, IL 62903-0997
(618) 457-0431
(618) 457-5199
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
016003389
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
016003389
—
IL
05
—
016004187
—
IL
05
—
016005370
—
IL
01
—
1013941392
RAILROAD MEDICARE
IL
01
—
1972533933
RAILROAD MEDICARE
IL
01
—
CI5845
RAILROAD MEDICARE
IL
Enumeration date
09/14/2006
Last updated
07/27/2020
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