# PHYSICIAN SERVICES CORPORATION OF SOUTHERN ILLINOIS S.C

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** PHYSICIAN SERVICES CORPORATION OF SOUTHERN ILLINOIS S.C.
- **Other names:** St. Marys Good Samaritan Medical Group Ultrasound
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1316271653
- **Legal business name:** PHYSICIAN SERVICES CORPORATION OF SOUTHERN ILLINOIS S.C.
- **Authorized official:** MR. RICHARD HUNTINGTON (VP FINANCIAL SERVICES)
- **Authorized official phone:** (618) 241-2204

## Contact information

- **Practice address:** 1708 JEFFERSON AVE, SUITE 100, MOUNT VERNON, IL 62864-4309
- **Practice address phone:** (618) 241-1856
- **Practice address fax:** (618) 241-1857
- **Mailing address:** 413 MAIN ST, MOUNT VERNON, IL 62864-3649
- **Mailing address phone:** (618) 532-9350
- **Mailing address fax:** (618) 532-9365

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 09/18/2009
- **Last updated:** 09/18/2009