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General NPI Number Information
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NPI Number | 1508844325
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Entity Type | Organization
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Legal Business Name | KASKASKIA MEDICAL CENTER, LTD
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Dates
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Enumeration Date | 01/03/2006
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Last Update Date | 03/26/2018
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Provider Practice Location Address
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Address Line | 1003 N 8TH ST
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City | VANDALIA
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State | IL
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Zip | 62471-1238
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Country | US
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Telephone | 618-283-4445
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Fax | 618-283-4446
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Provider Business Mailing Address
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Address Line | 1003 N 8TH ST
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City | VANDALIA
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State | IL
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Zip | 62471-1238
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Country | US
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Telephone | 618-283-4445
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Fax | 618-283-4446
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | MICHAEL DARMADI
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Credential | MD
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Telephone | 618-283-4445
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 036097600
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 036097600
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License Number State | IL
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