Organization
SOUTHERN ILLINOIS SURGICAL APPLIANCE CO.
Active
Parent organization
SOUTHERN ILLINIOIS SURGICAL APPLIANCE
Other names
SISA HOME MEDICAL
Organization subpart
Yes
Provider details
NPI number
Legal business name
SOUTHERN ILLINIOIS SURGICAL APPLIANCE
Authorized official
MR. RALPH RANDOLPH LEWIS (PRESIDENT)
(618) 932-3157
Entity
Organization
Contact information
Practice address
1301 W MAIN ST, CARBONDALE, IL 62901-2227
(618) 529-2406
(618) 351-7466
Mailing address
PO BOX 1667, MOUNT VERNON, IL 62864-0033
(618) 529-2406
(618) 351-7466
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
2032-1120
IL
332BC3200X
Customized Equipment (DME)
2032-1120
IL
332BX2000X
Oxygen Equipment & Supplies (DME)
2032-1120
IL
Other
Enumeration date
08/31/2006
Last updated
10/25/2010
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