| Tyler Wishau, | |
|
2 Good Samaritan Way Ste 420, Mount Vernon, IL 62864-2478 | |
| (618) 899-3900 | |
| Not Available |
| Full Name | Tyler Wishau |
|---|---|
| Gender | Male |
| Speciality | Podiatry |
| Experience | 12 Years |
| Location | 2 Good Samaritan Way Ste 420, Mount Vernon, Illinois |
| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144649856 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 213E00000X | Podiatrist | 016005806 (Illinois) | Secondary |
| 213ES0103X | Podiatrist - Foot & Ankle Surgery | 016005806 (Illinois) | Primary |
| Facility Name | Location | Facility Type |
|---|---|---|
| Ssm Health At Home Health-illinois | Mount vernon, IL | Home health agency |
| Ssm Health - Good Samaritan Hospital | Mount vernon, IL | Hospital |
| Ssm Health St Mary's Hospital -centralia | Centralia, IL | Hospital |
| Crossroads Community Hospital | Mount vernon, IL | Hospital |
| Hamilton Memorial Hospital | Mcleansboro, IL | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Physician Services Corporation Of Southern Illinois Inc | 9234022567 | 103 |
| Provider Name | Physician Services Corporation Of Southern Illinois Inc |
|---|---|
| Provider Type | Part B Supplier - Clinic/group Practice |
| Provider Identifiers | NPI Number: 1831101807 PECOS PAC ID: 9234022567 Enrollment ID: O20040304000583 |
| Mailing Address | Practice Location Address |
|---|---|
| Tyler Wishau, Po Box 955860, Saint Louis, MO 63195-2588 Ph: (636) 498-5944 | Tyler Wishau, 2 Good Samaritan Way Ste 420, Mount Vernon, IL 62864-2478 Ph: (618) 899-3900 |
S Thomas Sehy Dpm Llc Podiatrist Medicare: Medicare Enrolled Practice Location: 209 Crossroads Pl, Suite 130, Mount Vernon, IL 62864 Phone: 314-241-9411 Fax: 618-241-9414 | |
Thomas H. Nolen, D.p.m., P.c. Podiatrist Medicare: Not Enrolled in Medicare Practice Location: 1313 Main St, Mount Vernon, IL 62864 Phone: 618-242-8662 Fax: 618-242-4171 |