Organization
SIU PHYSICIANS & SURGEONS, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JERRY KRUSE MD (CEO)
(217) 545-7876
Entity
Organization
Contact information
Practice address
747 N RUTLEDGE ST, 3RD FLOOR, SPRINGFIELD, IL 62702-6700
(217) 545-0885
(217) 545-2588
Mailing address
PO BOX 19639, SPRINGFIELD, IL 62794-9639
(217) 545-8000
(217) 545-2101
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
IL
332BC3200X
Customized Equipment (DME)
Primary
—
IL
Other
Enumeration date
06/01/2007
Last updated
07/19/2023
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