Healthcare Provider Details

I. General information

NPI: 1265904486
Provider Name (Legal Business Name): HSHS MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2018
Last Update Date: 08/17/2022
Certification Date: 08/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 W TEMPLE AVE STE 1500
EFFINGHAM IL
62401-2121
US

IV. Provider business mailing address

3051 HOLLIS DR FL 2
SPRINGFIELD IL
62704-7452
US

V. Phone/Fax

Practice location:
  • Phone: 217-347-0458
  • Fax: 217-342-2992
Mailing address:
  • Phone: 217-492-9695
  • Fax: 217-492-9643

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: ANDREW WATSON
Title or Position: CFO
Credential:
Phone: 217-492-5806