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General NPI Number Information
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NPI Number | 1841216975
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Entity Type | Organization
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Legal Business Name | PHYSICIANS GROUP ASSOCIATES S C
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Dates
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Enumeration Date | 07/14/2006
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Last Update Date | 09/26/2014
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Provider Practice Location Address
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Address Line | 2901 OLD JACKSONVILLE RD
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City | SPRINGFIELD
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State | IL
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Zip | 62704-7437
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Country | US
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Telephone | 217-698-9722
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Fax | 217-391-0392
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Provider Business Mailing Address
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Address Line | PO BOX 500
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City | CHATHAM
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State | IL
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Zip | 62629-0500
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Country | US
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Telephone | 217-670-2424
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Fax | 217-670-2809
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Authorized Official
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Title or Position | PRESIDENT
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Name | JAMES LAFATA
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Credential | M.D.
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Telephone | 217-698-9722
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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