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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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