Provider Demographics
NPI:1063721447
Name:OVERSIGHT PHYSICIAN TECHNOLOGIES, PC
Entity type:Organization
Organization Name:OVERSIGHT PHYSICIAN TECHNOLOGIES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:217-342-3218
Mailing Address - Street 1:PO BOX 1527
Mailing Address - Street 2:
Mailing Address - City:EFFINGHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62401-1527
Mailing Address - Country:US
Mailing Address - Phone:217-342-3218
Mailing Address - Fax:217-342-3226
Practice Address - Street 1:813 N 3RD ST
Practice Address - Street 2:SUITE C
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401-3181
Practice Address - Country:US
Practice Address - Phone:217-342-3218
Practice Address - Fax:217-342-3226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-01
Last Update Date:2010-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty