Healthcare Provider Details

I. General information

NPI: 1033841192
Provider Name (Legal Business Name): HSHS MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2022
Last Update Date: 06/18/2024
Certification Date: 06/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 S MAIN ST
DIETERICH IL
62424-1128
US

IV. Provider business mailing address

3051 HOLLIS DR FL 2
SPRINGFIELD IL
62704-7450
US

V. Phone/Fax

Practice location:
  • Phone: 217-925-5730
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KEVIN LEWIS
Title or Position: CHIEF CLINICAL OFFICER
Credential:
Phone: 217-523-4747