# PHYSICIAN SERVICES CORP OF SOUTHERN ILLINOIS

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** PHYSICAN SEVICES CORP OF SOUTHERN ILLINOIS
- **Other names:** St Marys Good samaritan Medical Group
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1619109543
- **Legal business name:** PHYSICAN SEVICES CORP OF SOUTHERN ILLINOIS
- **Authorized official:** MR. RICHARD HUNTINGTON (VP FINANCIAL DEVELOPMENT)
- **Authorized official phone:** (618) 241-2204

## Contact information

- **Practice address:** 1250 W WHITTAKER ST, SALEM, IL 62881-1917
- **Practice address phone:** (618) 532-3950
- **Practice address fax:** (618) 532-9365
- **Mailing address:** 413 MAIN ST, MOUNT VERNON, IL 62864-3649
- **Mailing address phone:** (618) 532-3950
- **Mailing address fax:** (618) 532-9365

## Taxonomy

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

## Other

- **Enumeration date:** 08/11/2009
- **Last updated:** 08/11/2009