| Southern Illinois Associates Llc | |
|
6805 State Route 162 Ste 201 Maryville IL 62062-8530 | |
| (618) 288-5019 | |
| (618) 288-5059 |
| Full Name | Southern Illinois Associates Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 6805 State Route 162 Ste 201, Maryville, Illinois |
| Authorized Official Name and Position | Sanjay Nigam (PRESIDENT) |
| Authorized Official Contact | 6182885019 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southern Illinois Associates Llc 6805 State Route 162 Ste 201 Maryville IL 62062-8530 Ph: (618) 288-5019 | Southern Illinois Associates Llc 6805 State Route 162 Ste 201 Maryville IL 62062-8530 Ph: (618) 288-5019 |
| NPI Number | 1962427856 |
|---|---|
| Provider Enumeration Date | 07/13/2006 |
| Last Update Date | 08/18/2023 |
| Certification Date | 08/18/2023 |
| Medicare PECOS PAC ID | 2961489992 |
|---|---|
| Medicare Enrollment ID | O20040707000602 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962427856 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 036107024 (Illinois) | Primary |
| Provider Name | Sanjay Kumar Nigam |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1942278973 PECOS PAC ID: 1658362504 Enrollment ID: I20040520000394 |
| Provider Name | Thena G Poteat |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1114964566 PECOS PAC ID: 5294715041 Enrollment ID: I20040909001006 |
| Provider Name | Jenna M Collins Reed |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1346482494 PECOS PAC ID: 0547319592 Enrollment ID: I20090521000171 |
| Provider Name | Amy Lynn Hemann |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1558598102 PECOS PAC ID: 8921153040 Enrollment ID: I20090825000710 |
| Provider Name | Diana K Jarman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1932419710 PECOS PAC ID: 1658557251 Enrollment ID: I20110516000871 |
| Provider Name | Jaime R Mendoza |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689915811 PECOS PAC ID: 3971743345 Enrollment ID: I20130708000393 |
| Provider Name | Jennifer S Thery |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730509159 PECOS PAC ID: 3476777566 Enrollment ID: I20140611000511 |
| Provider Name | Janet Woloszynek |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1528622743 PECOS PAC ID: 6103252077 Enrollment ID: I20220212000200 |
| Provider Name | Joanna Haag |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760052310 PECOS PAC ID: 8022413350 Enrollment ID: I20230615003779 |
| Provider Name | Albert G Andrews |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1821112335 PECOS PAC ID: 5395195333 Enrollment ID: I20240123000495 |
| Provider Name | Emily Hinderliter |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1417459173 PECOS PAC ID: 2860833555 Enrollment ID: I20240513001702 |
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