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Organization
ST. MARYS GOOD SAMARITAN INC
Active
Organization
ST. MARYS GOOD SAMARITAN INC
Active
Other names
Carbondale beh. health center
Organization subpart
No
Provider details
NPI number
Authorized official
TAMMY SIMONTON (MNG BILLING)
(618) 436-6267
Entity
Organization
Contact information
Practice address
1034 E NOLEMAN ST, CENTRALIA, IL 62801-3348
(618) 436-6267
Mailing address
1034 E NOLEMAN ST, CENTRALIA, IL 62801-3348
(618) 436-6267
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3928382
BCBS OF ILLINOIS
IL
Enumeration date
11/26/2007
Last updated
11/26/2007
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