Healthcare Provider Details

I. General information

NPI: 1811940893
Provider Name (Legal Business Name): ASSOCIATED PHYSICIANS GROUP, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 07/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

916 TALON DR SUITE 102
O FALLON IL
62269-1848
US

IV. Provider business mailing address

916 TALON DR SUITE 102
O FALLON IL
62269-1848
US

V. Phone/Fax

Practice location:
  • Phone: 618-628-8211
  • Fax: 618-682-0883
Mailing address:
  • Phone: 618-628-8211
  • Fax: 618-682-0883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number042007668
License Number StateIL

VIII. Authorized Official

Name: MS. RENEE L CARSON
Title or Position: BILLING SUPERVISOR
Credential:
Phone: 618-628-8211