Provider Demographics
NPI:1316358187
Name:HSHS MEDICAL GROUP INC
Entity type:Organization
Organization Name:HSHS MEDICAL GROUP INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-492-9696
Mailing Address - Street 1:516 S CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:WENONA
Mailing Address - State:IL
Mailing Address - Zip Code:61377-7526
Mailing Address - Country:US
Mailing Address - Phone:815-853-4402
Mailing Address - Fax:815-853-4200
Practice Address - Street 1:516 S CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:WENONA
Practice Address - State:IL
Practice Address - Zip Code:61377-7526
Practice Address - Country:US
Practice Address - Phone:815-853-4402
Practice Address - Fax:815-853-4200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-15
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health