NPIMap

Organization Active NPI

Physician Services Corporation of Southern Illinois Inc

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

  • Non-Pharmacy Dispensing Site
  • Centralia, IL
National Provider Identifier
1215320460
Registry record updated Mar 12, 2015
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
Doing business as
St. Mary's Good Samaritan Medical Group
Practice address
1003 E McCord St
Centralia, IL 62801-3345
Phone
(618) 436-6633
Fax
(618) 242-1853
NPI assigned
Mar 12, 2015
Last updated
Mar 12, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 12, 2015

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 NU Primary

Addresses

Primary practice location

1003 E McCord St
Centralia, IL 62801-3345

Mailing address

1003 E McCord St
Centralia, IL 62801-3345
Phone (618) 436-6633

Other names 1

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

National Provider Directory

National Provider Directory
Tax ID family
Physicians Services Cor7 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": "1426118400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1426118400000",
    "number": "1215320460",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1003 E MCCORD ST",
            "city": "CENTRALIA",
            "state": "IL",
            "postal_code": "628013345",
            "telephone_number": "618-436-6633",
            "fax_number": "618-242-1853"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1003 E MCCORD ST",
            "city": "CENTRALIA",
            "state": "IL",
            "postal_code": "628013345",
            "telephone_number": "618-436-6633",
            "fax_number": "618-242-1853"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSICIAN SERVICES CORPORATION OF SOUTHERN ILLINOIS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-12",
        "last_updated": "2015-03-12",
        "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": "NU",
            "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 Centralia, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2015; 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.