Organization
SIU PHYSICIANS & SURGEONS, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JERRY KRUSE MD (CEO)
(217) 545-7876
Entity
Organization
Contact information
Practice address
720 N BOND ST, SPRINGFIELD, IL 62702-4952
(217) 545-8000
Mailing address
PO BOX 19639, SPRINGFIELD, IL 62794-9639
(217) 545-7578
(217) 545-1884
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
—
IL
207X00000X
Orthopaedic Surgery Physician
—
IL
207XP3100X
Pediatric Orthopaedic Surgery Physician
—
IL
207Y00000X
Otolaryngology Physician
—
IL
208600000X
Surgery Physician
—
IL
2086S0120X
Pediatric Surgery Physician
—
IL
2086S0122X
Plastic and Reconstructive Surgery Physician
—
IL
208800000X
Urology Physician
—
IL
2088P0231X
Pediatric Urology Physician
—
IL
208C00000X
Colon & Rectal Surgery Physician
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CB2589
RR MEDICARE
IL
01
—
CE8686
RR MEDICARE
IL
01
—
CE8687
RR MEDICARE
IL
01
—
CE8688
RR MEDICARE
IL
01
—
CE8689
RR MEDICARE
IL
01
—
CE8931
RR MEDICARE
IL
Enumeration date
07/21/2006
Last updated
07/21/2022
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