Organization
SOUTHERN ILLINOIS SURGICAL APPLIANCE CO
Active
Other names
SISA HOME MEDICAL
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT R LEWIS (PRESIDENT)
(618) 932-3157
Entity
Organization
Contact information
Practice address
555 S BELT W, BELLEVILLE, IL 62220-2485
(618) 234-7342
(618) 234-7332
Mailing address
555 S BELT W, BELLEVILLE, IL 62220-2485
(618) 234-7342
(618) 234-7332
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
20321120
IL
Other
Enumeration date
08/31/2006
Last updated
08/22/2020
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