Provider Demographics
NPI:1053437038
Name:SLEEP & NEUROLOGY CENTER OF SOUTHERN ILLINOIS, LLC
Entity type:Organization
Organization Name:SLEEP & NEUROLOGY CENTER OF SOUTHERN ILLINOIS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL VP FINANCE, CFO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:SNODSMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-899-1040
Mailing Address - Street 1:2 GOOD SAMARITAN WAY
Mailing Address - Street 2:SUITE 400
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IL
Mailing Address - Zip Code:62864-2478
Mailing Address - Country:US
Mailing Address - Phone:618-241-1869
Mailing Address - Fax:
Practice Address - Street 1:2 GOOD SAMARITAN WAY
Practice Address - Street 2:SUITE 400
Practice Address - City:MOUNT VERNON
Practice Address - State:IL
Practice Address - Zip Code:62864-2478
Practice Address - Country:US
Practice Address - Phone:618-241-1869
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========OtherTAX ID NUMBER