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Organization

SI03, INC.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. JEFF FANGER (GENERAL MANAGER)
(573) 388-2301
Entity
Organization

Contact information

Practice address
4711 NASH ROAD, SCOTT CITY, MO 63780
(573) 388-2301
(573) 388-2308
Mailing address
PO BOX 1715, CAPE GIRARDEAU, MO 63702
(573) 388-2301
(573) 388-2302

Taxonomy

Speciality
Code
Description
License number
State
335G00000X
Medical Foods Supplier
Primary

Other

Enumeration date
10/18/2011
Last updated
10/18/2011
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