Physician Services Corp of Southern Illinois
Organization Active NPI Rural Health Clinic/Center · Mount Vernon, IL
NPI 1548264237 · NPPES record last updated Apr 2, 2009
Key facts
- NPI
- 1548264237
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- License
- 0004705 (IL)
- Legal business name
- PHYSICIAN SERVICES CORP OF SOUTHERN ILLINOIS
- Practice address
- 8 Cusumano Professional Plaza Dr
Mount Vernon, IL 62864-6736 - Phone
- (618) 242-7819
- NPI assigned
- Jun 9, 2005
- Organization subpart
- Yes
- Parent organization (as reported)
- PHYSICIAN SERVICES CORP OF SOUTHERN ILLINOIS
Authorized official
- Name
- Mr. Richard Huntington
- Title
- VP Financial Development
- Phone
- (618) 241-2204
Corporate family (same tax ID) 8
Practitioners 1
-
Robert Parks, M.D.
National Provider Directory
- Tax ID family
- Good Samaritan Regional Health Center
- Part of
- Phys SVCS Corp of So Il
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | 0004705 | IL | Yes |
Addresses
Primary practice location
8 Cusumano Professional Plaza Dr
Mount Vernon, IL 62864-6736
Mailing address
413 Main St
Mount Vernon, IL 62864
Phone (618) 532-9350
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 430653587005 | Medicaid | IL |
Other names
- St marys Good Samaritan medical group
Other providers in Mount Vernon, IL
- Petersen Management Company, LLC
- Cynthia Dawn Phillips
- Jaylyn Phillips
- Shima Phoenix
- Physician Rural Health Clinic of Jefferson County
- Physician Services Corporation of Southern Illinois
- Physician Services Corporation of Southern Illinois Inc
- Physician Services Corporation of Southern Illinois Inc.
- Physician Services Corporation of Southern Illinois S.C
- Physicians Surgery Center at Good Samaritan, LLC
All providers in Mount Vernon, IL · Rural Health Clinic/Center in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 2, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.