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Organization
SOUTHERN ILLINOIS ALLERGY&ASTHMA CENTER,SC
Active
Organization
SOUTHERN ILLINOIS ALLERGY&ASTHMA CENTER,SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RONALD DEAN MINGS M.D. (PRESIDENT)
(618) 549-9385
Entity
Organization
Contact information
Practice address
1001 E MAIN ST, 2A PPE, CARBONDALE, IL 62901-3100
(618) 549-9385
(618) 549-8795
Mailing address
1001 E MAIN ST, 2A PPE, CARBONDALE, IL 62901-3100
(618) 549-9385
(618) 549-8795
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
027533
HEALTH ALLIANCE
IL
01
—
03927935
BLUE CROSS/BLUE SHIELD
IL
01
—
101269
HEALTHLINK
IL
Enumeration date
10/06/2006
Last updated
09/19/2007
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