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General NPI Number Information
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NPI Number | 1316271653
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Entity Type | Organization
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Legal Business Name | PHYSICIAN SERVICES CORPORATION OF SOUTHERN ILLINOIS S.C
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Dates
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Enumeration Date | 09/18/2009
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Last Update Date | 09/18/2009
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Provider Practice Location Address
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Address Line | 1708 JEFFERSON AVE SUITE 100
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City | MOUNT VERNON
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State | IL
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Zip | 62864-4309
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Country | US
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Telephone | 618-241-1856
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Fax | 618-241-1857
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Provider Business Mailing Address
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Address Line | 413 MAIN ST
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City | MOUNT VERNON
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State | IL
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Zip | 62864-3649
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Country | US
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Telephone | 618-532-9350
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Fax | 618-532-9365
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Authorized Official
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Title or Position | VP FINANCIAL SERVICES
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Name | MR. RICHARD HUNTINGTON
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Credential |
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Telephone | 618-241-2204
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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