Organization
PHYSICIAN SERVICES CORPORATION OF SOUTHERN ILLINOIS INC
Active
Other names
St. Mary's Good Samaritan Medical Group
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DELAND EVISCHI (VP FINANCE SMGSMG)
(618) 899-1040
Entity
Organization
Contact information
Practice address
602 S 42ND ST STE B, MOUNT VERNON, IL 62864-6264
(618) 899-3278
(618) 242-1853
Mailing address
602 S 42ND ST STE B, MOUNT VERNON, IL 62864-6264
(618) 899-3278
(618) 242-1853
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
—
—
Other
Enumeration date
10/22/2014
Last updated
10/22/2014
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