Healthcare Provider Details

I. General information

NPI: 1679236533
Provider Name (Legal Business Name): HSHS MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2021
Last Update Date: 08/17/2022
Certification Date: 08/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 W WASHINGTON ST # 1
NEWTON IL
62448-1264
US

IV. Provider business mailing address

3051 HOLLIS DR FL 2
SPRINGFIELD IL
62704-7450
US

V. Phone/Fax

Practice location:
  • Phone: 618-783-0954
  • Fax: 618-783-0958
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: ANDREW WATSON
Title or Position: CFO
Credential:
Phone: 217-492-5806