Organization
PHYSICIAN SERVICES CORPORATION OF SOUTHERN ILLINOIS
Active
Parent organization
PHYSCIAN SERVICES CORPORATION OF SOUTHERN ILLINOIS
Other names
St Marys Good Samaritan Medical Group
Organization subpart
Yes
Provider details
NPI number
Legal business name
PHYSCIAN SERVICES CORPORATION OF SOUTHERN ILLINOIS
Authorized official
TAMMY L SIMONTON (BILLING MNG)
(618) 436-6267
Entity
Organization
Contact information
Practice address
4218 LINCOLNSHIRE DR, MOUNT VERNON, IL 62864-2156
(618) 532-9350
Mailing address
4218 LINCOLNSHIRE DR, PO BOX 968, MOUNT VERNON, IL 62864-2156
(618) 532-9350
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
036113387
IL
Other
Enumeration date
02/04/2009
Last updated
02/04/2009
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