Organization
SOUTHERN ILLINOIS NEUROLOGIC INSTITUTE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GUY TIMOTHY BURROWS M.D. (OWNER)
(618) 239-6660
Entity
Organization
Contact information
Practice address
100 N JACKSON ST, BELLEVILLE, IL 62220-1427
(618) 239-6660
(618) 239-6662
Mailing address
100 N JACKSON ST, BELLEVILLE, IL 62220-1427
(618) 239-6660
(618) 239-6662
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
36078383
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
08207706
BLUE CROSS BLUE SHIELD
IL
01
—
130015602
RAILROAD MEDICARE
IL
Enumeration date
04/03/2007
Last updated
07/02/2008
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