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Organization

SOUTHERN ILLINOIS FOOT AND ANKLE CLINIC LTD

Active
Organization subpart
No

Provider details

NPI number
Authorized official
TAMI HEFNER (MEDICAL BILLER)
(618) 457-0431
Entity
Organization

Contact information

Practice address
1235 CEDAR CT, CARBONDALE, IL 62901-5335
(618) 457-0431
(618) 457-5199
Mailing address
PO BOX 997, CARBONDALE, IL 62903-0997
(618) 457-0431
(618) 457-5199

Taxonomy

Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
016003389
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
016003389
IL
05
016004187
IL
05
016005370
IL
01
1013941392
RAILROAD MEDICARE
IL
01
1972533933
RAILROAD MEDICARE
IL
01
CI5845
RAILROAD MEDICARE
IL
Enumeration date
09/14/2006
Last updated
07/27/2020
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