Organization
SOUTHERN ILLINOIS PHYSICIAN SERVICES, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
REBECCA J TIBEREND (BILLING OFFICER SUPERVISOR)
(618) 222-9999
Entity
Organization
Contact information
Practice address
4600 MEMORIAL DRIVE, SUITE 340, BELLEVILLE, IL 62226
(618) 222-9999
(618) 222-9337
Mailing address
P.O. BOX 23620, BELLEVILLE, IL 62223-0620
(618) 222-9999
(618) 222-9337
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
—
—
207VG0400X
Gynecology Physician
—
—
2084P0800X
Psychiatry Physician
—
—
208800000X
Urology Physician
—
—
Other
Enumeration date
10/09/2006
Last updated
06/21/2018
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