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General NPI Number Information
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NPI Number | 1023297553
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Entity Type | Organization
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Legal Business Name | PHYSICIANS SURGERY CENTER, LLC
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Dates
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Enumeration Date | 11/01/2007
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Last Update Date | 06/21/2018
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Provider Practice Location Address
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Address Line | 2601 W MAIN ST
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City | CARBONDALE
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State | IL
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Zip | 62901-1031
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Country | US
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Telephone | 618-549-5361
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Fax |
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Provider Business Mailing Address
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Address Line | 2601 W MAIN ST
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City | CARBONDALE
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State | IL
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Zip | 62901-1031
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Country | US
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Telephone | 618-549-5361
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. SHEFFIELD BOARDMAN
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Credential | M.D.
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Telephone | 618-549-5361
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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