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Organization

PHYSICIANS GROUP ASSOCIATES S C

Active
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Organization

PHYSICIANS GROUP ASSOCIATES S C

Active
Parent organization
PHYSICIANS GROUP ASSOCIATES SC
Organization subpart
Yes

Provider details

NPI number
Legal business name
PHYSICIANS GROUP ASSOCIATES SC
Authorized official
JAMES LAFATA M.D. (PRESIDENT)
(217) 698-9722
Entity
Organization

Contact information

Practice address
2901 OLD JACKSONVILLE ROAD, (LOCALITY 12), SPRINGFIELD, IL 62704
(217) 698-9722
(217) 391-0392
Mailing address
PO BOX 500, CHATHAM, IL 62629-0500
(217) 670-2424
(217) 670-2809

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
207R00000X
Internal Medicine Physician
Primary
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
207RP1001X
Pulmonary Disease Physician
207ZP0105X
Clinical Pathology/Laboratory Medicine Physician
2085R0202X
Diagnostic Radiology Physician
208600000X
Surgery Physician

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
020057300
BLACK LUNG
IL
01
08421024
BLUE CROSS BLUE SHIELD
IL
01
133586700
ACS-OWCP
IL
01
6394P
CATERPILLAR
IL
01
CD7143
RR MEDICARE GRP
IL
Enumeration date
07/06/2006
Last updated
09/26/2014
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