NPIMap

Organization Active NPI

Physician Services Corp of Southern Illinois

Doing business as St marys Good Samaritan medical group

  • Rural Health Clinic/Center
  • Mount Vernon, IL
National Provider Identifier
1548264237
Registry record updated Apr 2, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
0004705 Issued in IL
Legal business name
PHYSICIAN SERVICES CORP OF SOUTHERN ILLINOIS
Doing business as
St marys Good Samaritan medical group
Practice address
8 Cusumano Professional Plaza Dr
Mount Vernon, IL 62864-6736
Phone
(618) 242-7819
NPI assigned
Jun 9, 2005
Last updated
Apr 2, 2009By the provider in NPPES
Organization subpart
Yes
Parent organization
PHYSICIAN SERVICES CORP OF SOUTHERN ILLINOISAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 2, 2009

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

Authorized official

Name
Mr. Richard Huntington
Title
VP Financial Development
Phone
(618) 241-2204

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 0004705 IL Primary

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 names 1

  • St marys Good Samaritan medical group Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Good Samaritan Regional Health Center9 organizations share this tax ID, including this one
Part of
Physician Services Corporation of Southern Illinois

Other organizations with this tax ID 8

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

Locations

413 Main St
Mount Vernon, IL 62864

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": "1118275200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1238630400000",
    "number": "1548264237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "413 MAIN ST",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "62864",
            "telephone_number": "618-532-9350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8 CUSUMANO PROFESSIONAL PLAZA DR",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628646736",
            "telephone_number": "618-242-7819"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSICIAN SERVICES CORP OF SOUTHERN ILLINOIS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PHYSICIAN SERVICES CORP OF SOUTHERN ILLINOIS",
        "enumeration_date": "2005-06-09",
        "last_updated": "2009-04-02",
        "status": "A",
        "authorized_official_last_name": "HUNTINGTON",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_title_or_position": "VP FINANCIAL DEVELOPMENT",
        "authorized_official_telephone_number": "618-241-2204",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "IL",
            "license": "0004705",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St marys 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 Apr 2, 2009; 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.