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General NPI Number Information
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NPI Number | 1962937300
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Entity Type | Organization
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Legal Business Name | ASSOICATED PHYSICIANS GROUP LTD
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Dates
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Enumeration Date | 04/24/2017
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Last Update Date | 04/24/2017
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Provider Practice Location Address
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Address Line | 1011 SOUTH SUITE 3B
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City | COLUMBIA
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State | IL
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Zip | 62236
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Country | US
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Telephone | 618-628-8211
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Fax | 618-628-0883
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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 FALLON
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State | IL
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Zip | 62269-1848
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Country | US
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Telephone | 618-628-8211
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Fax | 618-628-0883
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Authorized Official
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Title or Position | BILLING SUP
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Name | RENEE L CARSON
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Credential |
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Telephone | 618-632-8611
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 042617962
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License Number State | IL
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