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General NPI Number Information
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NPI Number | 1821357807
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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 | 05/10/2012
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Last Update Date | 09/12/2012
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Provider Practice Location Address
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Address Line | 20 PROFESSIONAL PARK DR SUITE A
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City | MARYVILLE
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State | IL
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Zip | 62062-5830
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Country | US
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Telephone | 618-205-3655
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Fax |
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Provider Business Mailing Address
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Address Line | 916 TALON DR SUITE 102
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City | O FALLEN
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State | IL
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Zip | 62269-1848
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Country | US
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Telephone |
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Fax |
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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 | DO
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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 | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number |
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License Number State | IL
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