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General NPI Number Information
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NPI Number | 1215320460
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Entity Type | Organization
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Legal Business Name | PHYSICIAN SERVICES CORPORATION OF SOUTHERN ILLINOIS INC
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Dates
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Enumeration Date | 03/12/2015
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Last Update Date | 03/12/2015
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Provider Practice Location Address
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Address Line | 1003 E MCCORD ST
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City | CENTRALIA
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State | IL
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Zip | 62801-3345
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Country | US
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Telephone | 618-436-6633
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Fax | 618-242-1853
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Provider Business Mailing Address
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Address Line | 1003 E MCCORD ST
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City | CENTRALIA
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State | IL
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Zip | 62801-3345
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Country | US
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Telephone | 618-436-6633
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Fax | 618-242-1853
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Authorized Official
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Title or Position | VP FINANCE SMGSMG
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Name | MR. DELAND EVISCHI
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Credential |
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Telephone | 618-899-1040
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number |
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License Number State |
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