Organization
PHYSICIANS SURGICAL CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN C WILSON JR. (CFO)
(615) 346-4100
Entity
Organization
Contact information
Practice address
311 W LINCOLN ST, STE. 300, BELLEVILLE, IL 62220-1902
(618) 233-7077
(618) 233-2814
Mailing address
311 W LINCOLN ST, STE. 300, BELLEVILLE, IL 62220-1902
(618) 233-7077
(618) 233-2814
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
042-006796
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
371267690001
—
IL
Enumeration date
06/17/2006
Last updated
05/04/2012
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