Provider Demographics
NPI:1316271653
Name:PHYSICIAN SERVICES CORPORATION OF SOUTHERN ILLINOIS S.C
Entity type:Organization
Organization Name:PHYSICIAN SERVICES CORPORATION OF SOUTHERN ILLINOIS S.C
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP FINANCIAL SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:HUNTINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-241-2204
Mailing Address - Street 1:413 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IL
Mailing Address - Zip Code:62864-3649
Mailing Address - Country:US
Mailing Address - Phone:618-532-9350
Mailing Address - Fax:618-532-9365
Practice Address - Street 1:1708 JEFFERSON AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:MOUNT VERNON
Practice Address - State:IL
Practice Address - Zip Code:62864-4309
Practice Address - Country:US
Practice Address - Phone:618-241-1856
Practice Address - Fax:618-241-1857
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHYSICIAN SERVICES CORPORATION OF SOUTHERN ILLINOIS S.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-09-18
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center