MEDICARE: CARDIOVASCULAR SPECIALISTS OF ILLINOIS LTD

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	207RC0000X	Cardiovascular Disease Physician

General Provider Information

NPI Number	:	1851468979
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARDIOVASCULAR SPECIALISTS OF ILLINOIS LTD

Provider Business Mailing Address
First Line	:	605 N 12TH ST
Second Line	:
City	:	MOUNT VERNON
State	:	IL
Zip	:	62864-2857
Country	:	US
Telephone Number	:	618-241-1350
Fax Number	:	618-241-1353

Provider Business Practice Location Address
First Line	:	605 N 12TH ST
Second Line	:
City	:	MOUNT VERNON
State	:	IL
Zip	:	62864-2857
Country	:	US
Telephone Number	:	618-241-1350
Fax Number	:	618-241-1353

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. BRIAN C JONES
Credential	:	MD
Telephone Number	:	618-241-1350

Provider Enumeration Date	:	11/30/2006
Last Update Date	:	01/25/2011

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