| Physician Services Corp Of Southern Illinois | |
|
430 N Pleasant Ave Centralia IL 62801-3006 | |
| (618) 532-9350 | |
| Not Available |
| Full Name | Physician Services Corp Of Southern Illinois |
|---|---|
| Speciality | Obstetrics & Gynecology |
| Location | 430 N Pleasant Ave, Centralia, Illinois |
| Authorized Official Name and Position | Tammy Simonton (MNG) |
| Authorized Official Contact | 6184366267 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Physician Services Corp Of Southern Illinois 430 N Pleasant Ave Centralia IL 62801-3006 Ph: (618) 532-9350 | Physician Services Corp Of Southern Illinois 430 N Pleasant Ave Centralia IL 62801-3006 Ph: (618) 532-9350 |
| NPI Number | 1740421536 |
|---|---|
| Provider Enumeration Date | 03/09/2009 |
| Last Update Date | 03/12/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740421536 | NPI | - | NPPES |
| 1831101807 | Other | IL | CMS GRP NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | 002642 (Illinois) | Secondary |
| 207V00000X | Obstetrics & Gynecology | 036116791 (Illinois) | Primary |
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