# SOUTHERN ILLINOIS FAMILY FOOT CARE, LLC

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

## Provider details

- **NPI number:** 1972843613
- **Authorized official:** DR. BRIAN LEE D.P.M. (PRESIDENT)
- **Authorized official phone:** (618) 244-3668

## Contact information

- **Practice address:** 221 N 27TH ST, MOUNT VERNON, IL 62864-2941
- **Practice address phone:** (618) 244-3668
- **Mailing address:** 221 N 27TH ST, MOUNT VERNON, IL 62864-2941
- **Mailing address phone:** (618) 244-3668

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | 016003846 | IL | Yes |

## Other

- **Enumeration date:** 02/17/2013
- **Last updated:** 05/16/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1285744060 | — | IL |