NPIMap

Organization Active NPI

Physician Services Corporation of Southern Illinois Inc

  • Non-Pharmacy Dispensing Site
  • Mount Vernon, IL
National Provider Identifier
1154725976
Registry record updated Oct 22, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Non-Pharmacy Dispensing SiteTaxonomy code 332900000X
Legal business name
PHYSICIAN SERVICES CORPORATION OF SOUTHERN ILLINOIS INC
Practice address
602 S 42ND St Ste B
Mount Vernon, IL 62864-6264
Phone
(618) 899-3278
Fax
(618) 242-1853
NPI assigned
Oct 22, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Deland Evischi
Title
VP Finance Smgsmg
Phone
(618) 899-1040

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Non-Pharmacy Dispensing Site 332900000X Primary

Addresses

Primary practice location

602 S 42ND St Ste B
Mount Vernon, IL 62864-6264

Mailing address

602 S 42ND St Ste B
Mount Vernon, IL 62864-6264
Phone (618) 899-3278

Other names 1

  • St. Mary's Good Samaritan Medical Group Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Phys SVCS Corp of So Il7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1413936000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1413936000000",
    "number": "1154725976",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "602 S 42ND ST STE B",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628646264",
            "telephone_number": "618-899-3278",
            "fax_number": "618-242-1853"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "602 S 42ND ST STE B",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628646264",
            "telephone_number": "618-899-3278",
            "fax_number": "618-242-1853"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSICIAN SERVICES CORPORATION OF SOUTHERN ILLINOIS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-22",
        "last_updated": "2014-10-22",
        "status": "A",
        "authorized_official_last_name": "EVISCHI",
        "authorized_official_first_name": "DELAND",
        "authorized_official_title_or_position": "VP FINANCE SMGSMG",
        "authorized_official_telephone_number": "618-899-1040",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St. Mary's Good Samaritan Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mount Vernon, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.