Organization
SOUTHERN ILLINOIS SURGICAL APPLIANCE CO
Active
Other names
SISA Home Medical
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RALPH RANDOLPH LEWIS (PRESIDENT)
(618) 932-3157
Entity
Organization
Contact information
Practice address
19 W FRANKFORT PLZ, WEST FRANKFORT, IL 62896-4964
(618) 932-3157
(618) 932-3031
Mailing address
19 W FRANKFORT PLZ, WEST FRANKFORT, IL 62896-4964
(618) 932-3157
(618) 932-3031
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
2032 1120
IL
332BX2000X
Oxygen Equipment & Supplies (DME)
2032-1120
IL
Other
Enumeration date
11/08/2005
Last updated
04/20/2008
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