# PHYSICIAN SERVICES CORPORATION OF SOUTHERN ILLINOIS INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** SSM Health Medical Group
- **Organization subpart:** No

## Provider details

- **NPI number:** 1780688671
- **Authorized official:** MR. DEE EVISCHI (VP FINANCE MEDICAL GROUP)
- **Authorized official phone:** (618) 899-1040

## Contact information

- **Practice address:** 1441 W BROADWAY, CENTRALIA, IL 62801-0001
- **Practice address phone:** (618) 532-9050
- **Mailing address:** 1411 W BROADWAY, CENTRALIA, IL 62801-0001
- **Mailing address phone:** (618) 532-9050
- **Mailing address fax:** (618) 532-9365

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QR1300X | Rural Health Clinic/Center | 0002642 | IL | Yes |

## Other

- **Enumeration date:** 06/08/2005
- **Last updated:** 08/26/2015