Organization
SKIN CARE CENTER OF SOUTHERN IL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GEORGE THOMAS NAHASS M.D (OWNER)
(618) 244-0031
Entity
Organization
Contact information
Practice address
4107 S WATER TOWER PL, MOUNT VERNON, IL 62864-6293
(618) 244-0031
(618) 244-0056
Mailing address
4107 S WATER TOWER PL, MOUNT VERNON, IL 62864-6293
(618) 244-0031
(618) 244-0056
Taxonomy
Speciality
Code
Description
License number
State
207ND0900X
Dermatopathology Physician
Primary
036094700
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
152566974412
—
IL
01
—
CH5023
MEDICARE RAILROAD
IL
Enumeration date
03/23/2007
Last updated
06/25/2013
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