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NPI Code Detail

MEDICARE: NEW CENTURY PHYSICIANS OF SOUTHERN ILLINOIS INC

MEDICARE: NEW CENTURY PHYSICIANS 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
1207P00000XEmergency Medicine Physician1443332IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
110032029OTHERILBC/BS GRP PROVIDER #
2610626900OTHERILFEDERAL BLACK LUNG
3610626900OTHERILDEPT OF LABOR
4610626900OTHERILEEOIC

General Provider Information

NPI Number : 1922007533
Entity Type Code : Organization
Provider Name (Legal Business Name) : NEW CENTURY PHYSICIANS OF SOUTHERN ILLINOIS INC
Provider Business Mailing Address
First Line : 4750 HEMPSTEAD STATION DR
Second Line :
City : KETTERING
State : OH
Zip : 45429-5164
Country : US
Telephone Number : 800-875-0136
Fax Number : 937-619-4231
Provider Business Practice Location Address
First Line : 3333 W DEYOUNG ST
Second Line :
City : MARION
State : IL
Zip : 62959-5884
Country : US
Telephone Number : 618-998-7000
Fax Number : 618-997-6589
Authorized Official
Title or Position : CEO
Name : DR. WILLIAM A COLE JR.
Credential : MD
Telephone Number : 800-726-3627
Provider Enumeration Date : 07/15/2005
Last Update Date : 10/29/2008

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Directions to “NEW CENTURY PHYSICIANS OF SOUTHERN ILLINOIS INC ” Practice Location

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