Organization
PHYSICIAN SERVICES CORP OF SOUTHERN ILLINOIS
Active
Parent organization
PHYSICIAN SERVICES CORP OF SOUTHERN ILLINOIS
Other names
St marys good samaritan medical group
Organization subpart
Yes
Provider details
NPI number
Legal business name
PHYSICIAN SERVICES CORP OF SOUTHERN ILLINOIS
Authorized official
TAMMY SIMONTON (MNG)
(618) 436-6267
Entity
Organization
Contact information
Practice address
430 N PLEASANT AVE, CENTRALIA, IL 62801-3006
(618) 532-9350
Mailing address
430 N PLEASANT AVE, CENTRALIA, IL 62801-3006
(618) 532-9350
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
036116791
IL
261QR1300X
Rural Health Clinic/Center
002642
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1831101807
CMS GRP NPI
IL
Enumeration date
03/09/2009
Last updated
03/12/2009
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