NPIMap

Organization Active NPI

Physician Services Corporation of Southern Illinois Inc

  • Rural Health Clinic/Center
  • Centralia, IL
National Provider Identifier
1780688671
Registry record updated Aug 26, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
0002642 Issued in IL
Legal business name
PHYSICIAN SERVICES CORPORATION OF SOUTHERN ILLINOIS INC
Practice address
1441 W Broadway
Centralia, IL 62801-0001
Phone
(618) 532-9050
NPI assigned
Jun 8, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 26, 2015

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

Authorized official

Name
Mr. Dee Evischi
Title
VP Finance Medical Group
Phone
(618) 899-1040

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 0002642 IL Primary

Addresses

Primary practice location

1441 W Broadway
Centralia, IL 62801-0001

Mailing address

1411 W Broadway
Centralia, IL 62801-0001
Phone (618) 532-9050

Other identifiers 1

IdentifierTypeStateIssuer
1831101807OtherILNPI PSCSI GRP

Other names 1

  • SSM Health 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.

Locations

1411 W Broadway
Centralia, IL 62801

1441 W Broadway
Centralia, IL 62801
Phone (618) 532-0810

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1118188800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1440547200000",
    "number": "1780688671",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1411 W BROADWAY",
            "city": "CENTRALIA",
            "state": "IL",
            "postal_code": "628010001",
            "telephone_number": "618-532-9050",
            "fax_number": "618-532-9365"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1441 W BROADWAY",
            "city": "CENTRALIA",
            "state": "IL",
            "postal_code": "628010001",
            "telephone_number": "618-532-9050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSICIAN SERVICES CORPORATION OF SOUTHERN ILLINOIS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-08",
        "last_updated": "2015-08-26",
        "status": "A",
        "authorized_official_last_name": "EVISCHI",
        "authorized_official_first_name": "DEE",
        "authorized_official_title_or_position": "VP FINANCE MEDICAL GROUP",
        "authorized_official_telephone_number": "618-899-1040",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "IL",
            "license": "0002642",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI PSCSI GRP",
            "identifier": "1831101807",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SSM Health 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 Aug 26, 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.