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NPI Code Detail

MEDICARE: PHYSICIAN SERVICES CORPORATION OF SOUTHERN ILLINOIS INC

MEDICARE: PHYSICIAN SERVICES CORPORATION OF SOUTHERN ILLINOIS INC
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
1261QR1300XRural Health Clinic/Center0002642IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11831101807OTHERILNPI PSCSI GRP

General Provider Information

NPI Number : 1780688671
Entity Type Code : Organization
Provider Name (Legal Business Name) : PHYSICIAN SERVICES CORPORATION OF SOUTHERN ILLINOIS INC
Provider Business Mailing Address
First Line : 1411 W BROADWAY
Second Line :
City : CENTRALIA
State : IL
Zip : 62801-0001
Country : US
Telephone Number : 618-532-9050
Fax Number : 618-532-9365
Provider Business Practice Location Address
First Line : 1441 W BROADWAY
Second Line :
City : CENTRALIA
State : IL
Zip : 62801-0001
Country : US
Telephone Number : 618-532-9050
Fax Number :
Authorized Official
Title or Position : VP FINANCE MEDICAL GROUP
Name : MR. DEE EVISCHI
Credential :
Telephone Number : 618-899-1040
Provider Enumeration Date : 06/08/2005
Last Update Date : 08/26/2015

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Directions to “PHYSICIAN SERVICES CORPORATION OF SOUTHERN ILLINOIS INC ” Practice Location

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