Organization
PHYSICIANS GROUP ASSOCIATES S C
Active
Parent organization
PHYSICIANS GROUP ASSOCIATES SC
Organization subpart
Yes
Provider details
NPI number
Legal business name
PHYSICIANS GROUP ASSOCIATES SC
Authorized official
JAMES LAFATA M.D. (PRESIDENT)
(217) 698-9722
Entity
Organization
Contact information
Practice address
2901 OLD JACKSONVILLE RD, SPRINGFIELD, IL 62704-7437
(217) 698-9722
(217) 391-0392
Mailing address
PO BOX 500, CHATHAM, IL 62629-0500
(217) 670-2424
(217) 670-2809
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
—
—
363L00000X
Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020057300
BLACK LUNG
IL
01
—
08421024
BLUE CROSS BLUE SHIELD
IL
01
—
133586700
ACS-OWCP
IL
01
—
14D0949277
CLIA CERT#
IL
01
—
6394P
CATERPILLAR
IL
01
—
CD7143
RR MEDICARE GRP
IL
Enumeration date
07/14/2006
Last updated
09/26/2014
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