| Organization Name: | SI03, INC. |
| NPI Number: | 1144505447 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JEFF FANGER (GENERAL MANAGER) |
| Mailing Address: | 4711 Nash Road Scott City |
| State: | MO US |
| Postal Code: | 63780 |
| Phone Number: | 5733882301 |
| Fax Number: | 5733882308 |
| NPI Enumeration Date: | 10/18/2011 |
| NPI Last Update Date: | 10/18/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 335G00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Medical Foods Supplier |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A supplier of special replacement foods for clients with errors of metabolism that prohibit them from eating a regular diet. Medical foods are lacking in the compounds which cause complications of the metabolic disorder, and are not generally available in grocery stores, health food stores, or pharmacies. |