Organization
SILOAM LLC
Active
Other names
SOUTHERN ILLINOIS CANCER CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
JACK T SANDFORD MD (OWNER)
(618) 985-4000
Entity
Organization
Contact information
Practice address
10286 FLEMING RD, CARTERVILLE, IL 62918-3351
(918) 985-4000
Mailing address
171 TECHNOLOGY DR, SUITE 200, BOALSBURG, PA 16827-1530
(814) 237-8627
(814) 238-0083
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036104428
—
IL
01
—
10027422
IL BCBS
IL
01
—
455350
HEALTHLINK
IL
Enumeration date
05/24/2006
Last updated
07/21/2022
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