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General NPI Number Information
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NPI Number | 1235467606
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Entity Type | Organization
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Legal Business Name | ASSOCIATED PHYSICIANS GROUP LTD
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Dates
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Enumeration Date | 11/24/2009
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Last Update Date | 07/08/2010
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Provider Practice Location Address
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Address Line | 12 WOLF CREEK DR SUITE 200
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City | SWANSEA
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State | IL
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Zip | 62226-2314
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Country | US
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Telephone | 618-239-9910
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Fax | 618-239-9795
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Provider Business Mailing Address
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Address Line | 12 WOLF CREEK DRIVE SUITE 200
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City | SWANSEA
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State | IL
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Zip | 62226
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Country | US
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Telephone | 618-239-9910
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Fax | 618-239-9795
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Authorized Official
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Title or Position | OWNER
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Name | JOHN S VICK
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Credential | D.C.
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Telephone | 618-628-8211
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 038007328
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License Number State | IL
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