| Shaji A Mohammed, | |
|
1 Good Samaritan Way, Mt. Vernon, IL 62864-1010 | |
| (618) 899-1006 | |
| Not Available |
| Full Name | Shaji A Mohammed |
|---|---|
| Gender | Male |
| Speciality | Internal Medicine |
| Location | 1 Good Samaritan Way, Mt. Vernon, Illinois |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316504939 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208M00000X | Hospitalist | 036161378 (Illinois) | Secondary |
| 207R00000X | Internal Medicine | 036161378 (Illinois) | Primary |
| Entity Name | St Marys Hospital Centralia Illinois |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1770687196 PECOS PAC ID: 6709788920 Enrollment ID: O20040127000118 |
| Mailing Address | Practice Location Address |
|---|---|
| Shaji A Mohammed, 1005 Broadway, Quincy, IL 62301-2834 Ph: (217) 223-8400 | Shaji A Mohammed, 1 Good Samaritan Way, Mt. Vernon, IL 62864-1010 Ph: (618) 899-1006 |
Dr. Stanton G Schultz, M.D. Internal Medicine Medicare: Not Enrolled in Medicare Practice Location: 416 North 12th Street, Southern Illinois Consultants For Kidney Disease, S.c., Mt. Vernon, IL 62864 Phone: 618-244-4850 Fax: 618-244-7985 | |
Dr. Fadi Michel Shamsham, M.D. Internal Medicine Medicare: Accepting Medicare Assignments Practice Location: 4115 S. Water Tower Place, Mt. Vernon, IL 62864 Phone: 618-204-5462 Fax: 618-204-5472 |