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Organization
PHYSICIAN SERVICES CORPORATION OF SOUTHERN ILLINOIS INC.
Active
Organization
PHYSICIAN SERVICES CORPORATION OF SOUTHERN ILLINOIS INC.
Active
Other names
SSM Health Medical Group
Organization subpart
No
Provider details
NPI number
Authorized official
DELAND EVISCHI (VP FINANCE SMGSMG)
(618) 899-1040
Entity
Organization
Contact information
Practice address
4218 LINCOLNSHIRE DR, MOUNT VERNON, IL 62864-2156
(618) 899-3600
Mailing address
4218 LINCOLNSHIRE DR, MOUNT VERNON, IL 62864-2156
(618) 899-3600
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
207Y00000X
Otolaryngology Physician
—
—
208000000X
Pediatrics Physician
—
—
208600000X
Surgery Physician
—
—
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
—
—
261QR1300X
Rural Health Clinic/Center
—
IL
363A00000X
Physician Assistant
—
—
Other
Enumeration date
08/11/2006
Last updated
08/25/2015
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