Organization
PHYSICIANS SURGERY CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHEFFIELD BOARDMAN M.D. (MEDICAL DIRECTOR)
(618) 549-5361
Entity
Organization
Contact information
Practice address
2601 W MAIN ST, CARBONDALE, IL 62901-1031
(618) 549-5361
Mailing address
2601 W MAIN ST, CARBONDALE, IL 62901-1031
(618) 549-5361
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
014101
HEALTH ALLIANCE
—
01
—
328614
GROUP HEALTH PLANS
—
01
—
50935
BLUE CROSS OF ILLINOIS
IL
01
—
878466
HEALTH LINK
—
Enumeration date
11/01/2007
Last updated
06/21/2018
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