| Organization Name: | HEALTH PLAN OF SOUTHERN ILLINOIS, INC. |
| NPI Number: | 1295723187 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JAMES DURHAM (MEDICAL DIRECTOR) |
| Mailing Address: | 108 Egyptian Ave Christopher |
| State: | IL US |
| Postal Code: | 628221642 |
| Phone Number: | 6187242486 |
| Fax Number: | 6187247555 |
| NPI Enumeration Date: | 10/13/2005 |
| NPI Last Update Date: | 04/20/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QR1300X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Rural Health |
| Taxonomy Definition: | |