# SI03, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1144505447
- **Authorized official:** MR. JEFF FANGER (GENERAL MANAGER)
- **Authorized official phone:** (573) 388-2301

## Contact information

- **Practice address:** 4711 NASH ROAD, SCOTT CITY, MO 63780
- **Practice address phone:** (573) 388-2301
- **Practice address fax:** (573) 388-2308
- **Mailing address:** PO BOX 1715, CAPE GIRARDEAU, MO 63702
- **Mailing address phone:** (573) 388-2301
- **Mailing address fax:** (573) 388-2302

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 335G00000X | Medical Foods Supplier | — | NULL | Yes |

## Other

- **Enumeration date:** 10/18/2011
- **Last updated:** 10/18/2011