Organization
PHYSICIANS GROUP ASSOCIATES SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAMES LAFATA (PRESIDENT)
(217) 698-9722
Entity
Organization
Contact information
Practice address
111 N MAIN ST, NEW BERLIN, IL 62670-4593
(217) 488-2201
(217) 488-3508
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
036064159
IL
261QR1300X
Rural Health Clinic/Center
Primary
—
—
363LF0000X
Family Nurse Practitioner
209-003289
IL
Other
Enumeration date
11/13/2009
Last updated
07/24/2013
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