# PHYSICIAN SERVICES CORP OF SOUTHERN ILLINOIS

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** PHYSICIAN SERVICES CORP OF SOUTHERN ILLINOIS
- **Other names:** St marys Good Samaritan medical group
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1548264237
- **Legal business name:** PHYSICIAN SERVICES CORP OF SOUTHERN ILLINOIS
- **Authorized official:** MR. RICHARD HUNTINGTON (VP FINANCIAL DEVELOPMENT)
- **Authorized official phone:** (618) 241-2204

## Contact information

- **Practice address:** 8 CUSUMANO PROFESSIONAL PLAZA DR, MOUNT VERNON, IL 62864-6736
- **Practice address phone:** (618) 242-7819
- **Mailing address:** 413 MAIN ST, MOUNT VERNON, IL 62864
- **Mailing address phone:** (618) 532-9350

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QR1300X | Rural Health Clinic/Center | 0004705 | IL | Yes |

## Other

- **Enumeration date:** 06/09/2005
- **Last updated:** 04/02/2009