MEDICARE: PHYSICIAN SERVICES CORP OF SOUTHERN ILLINOIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR1300X	Rural Health Clinic/Center	0004705	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548264237
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYSICIAN SERVICES CORP OF SOUTHERN ILLINOIS

Provider Business Mailing Address
First Line	:	413 MAIN ST
Second Line	:
City	:	MOUNT VERNON
State	:	IL
Zip	:	62864
Country	:	US
Telephone Number	:	618-532-9350
Fax Number	:

Provider Business Practice Location Address
First Line	:	8 CUSUMANO PROFESSIONAL PLAZA DR
Second Line	:
City	:	MOUNT VERNON
State	:	IL
Zip	:	62864-6736
Country	:	US
Telephone Number	:	618-242-7819
Fax Number	:

Authorized Official
Title or Position	:	VP FINANCIAL DEVELOPMENT
Name	:	MR. RICHARD HUNTINGTON
Credential	:
Telephone Number	:	618-241-2204

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	04/02/2009

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Directions to “PHYSICIAN SERVICES CORP OF SOUTHERN ILLINOIS ” Practice Location

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