Healthcare Provider Details

I. General information

NPI: 1417906959
Provider Name (Legal Business Name): HSHS MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 08/17/2022
Certification Date: 08/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 E. TREMONT SUITE A
HILLSBORO IL
62049-1509
US

IV. Provider business mailing address

1220 E. TREMONT SUITE A
HILLSBORO IL
62049-1509
US

V. Phone/Fax

Practice location:
  • Phone: 217-532-9471
  • Fax: 217-532-9476
Mailing address:
  • Phone: 217-532-9471
  • Fax: 217-532-9476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number36046053
License Number StateIL

VIII. Authorized Official

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