Organization
SI MEDICAL, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TRACY ASKARI (VICE PRESIDENT)
(618) 993-6641
Entity
Organization
Contact information
Practice address
1909 W COOLIDGE AVE, MARION, IL 62959-1097
(618) 997-5677
(618) 998-1451
Mailing address
1909 W COOLIDGE AVE, MARION, IL 62959-1097
(618) 997-5677
(618) 998-1451
Taxonomy
Speciality
Code
Description
License number
State
133VN1006X
Metabolic Nutrition Registered Dietitian
164.003714
IL
363AM0700X
Medical Physician Assistant
85.003452
IL
363LP2300X
Primary Care Nurse Practitioner
209.002243
IL
363LP2300X
Primary Care Nurse Practitioner
Primary
209.005527
IL
Other
Enumeration date
06/06/2012
Last updated
05/20/2014
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