NPIMap

Organization Active NPI

United Skin Specialists Illinois LTD, PC

Doing business as Skin Care Center of S. Illinois - Centralia

  • Dermatology Physician
  • Mount Vernon, IL
National Provider Identifier
1467955179
Registry record updated Jun 16, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
UNITED SKIN SPECIALISTS ILLINOIS LTD, PC
Doing business as
Skin Care Center of S. Illinois - Centralia
Skin Care Center of S. Illinois - Mt. Vernon
Practice address
4107 S Water Tower PL
Mount Vernon, IL 62864-6293
Phone
(618) 244-0031
NPI assigned
Mar 9, 2018
Last updated
Jun 16, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2018

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

Authorized official

Name
Jim Feinstein
Title
Preseident/Coo
Phone
(763) 746-0030

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X NU Primary
Dermatopathology Physician 207ND0900X NU

Addresses

Primary practice location

4107 S Water Tower PL
Mount Vernon, IL 62864-6293

Mailing address

2 Carlson Pkwy N Ste 240
Plymouth, MN 55447-4485
Phone (763) 746-0030

Other practice location 1

1054 Martin Luther King Dr
Centralia, IL 62801-3000
Phone (618) 244-0031

Other names 2

  • Skin Care Center of S. Illinois - Centralia Doing business as
  • Skin Care Center of S. Illinois - Mt. Vernon Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1520553600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529107200000",
    "number": "1467955179",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 CARLSON PKWY N STE 240",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554474485",
            "telephone_number": "763-746-0030",
            "fax_number": "763-367-7977"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4107 S WATER TOWER PL",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628646293",
            "telephone_number": "618-244-0031"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1054 Martin Luther King Dr",
            "address_purpose": "LOCATION",
            "city": "Centralia",
            "state": "IL",
            "postal_code": "628013000",
            "country_code": "US",
            "telephone_number": "618-244-0031",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "UNITED SKIN SPECIALISTS ILLINOIS LTD, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-09",
        "last_updated": "2018-06-16",
        "status": "A",
        "authorized_official_last_name": "FEINSTEIN",
        "authorized_official_first_name": "JIM",
        "authorized_official_title_or_position": "PRESEIDENT/COO",
        "authorized_official_telephone_number": "763-746-0030"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207ND0900X",
            "taxonomy_group": "",
            "desc": "Dermatology, Dermatopathology",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Skin Care Center of S. Illinois - Centralia",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Skin Care Center of S. Illinois - Mt. Vernon",
            "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 Jun 16, 2018; 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.