Organization
SOUTHERN ILLINOIS PULMONARY CONSULTANTS, LTD.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DEBORAH J RAU (OFFICE MANAGER)
(618) 235-4898
Entity
Organization
Contact information
Practice address
340 W LINCOLN ST STE 300, BELLEVILLE, IL 62220-1900
(618) 235-4898
(618) 235-9573
Mailing address
340 W LINCOLN ST STE 300, BELLEVILLE, IL 62220-1900
(618) 235-4898
(618) 235-9573
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
223571
BLACK LUNG
IL
01
—
4466076
AETNA
IL
01
—
645659
BC BS PENNSYLVANIA
PA
01
—
8215136
BC BS ILLINOIS
IL
01
—
L013062
TRICARE
IL
Enumeration date
01/17/2007
Last updated
08/22/2020
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