St Marys Good Samaritan Medical Group

LBN: Physician Services Corp Of Southern Illinois
St Marys Good Samaritan Medical Group is an health care organization with primary practice located at 8 Cusumano Professional Plaza Dr , Mount Vernon IL 62864-6736. The organization recently has only one registered license in Ambulatory Health Care Facilities / Rural Health, which is considered as the primary health care specialty. Physician Services Corp Of Southern Illinois can be contacted via phone (618) 242-7819, or through Huntington, Richard via phone (618) 241-2204.

Contact Information

Primary practice address
8 Cusumano Professional Plaza Dr Mount Vernon IL 62864-6736
Phone: (618) 242-7819
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Huntington, Richard
Phone: (618) 241-2204

Health care specialties

SpecialtyCodeLicense #State
Ambulatory Health Care Facilities / Rural Health 261QR1300X 0004705 Illinois

Profile Details

NPI number 1548264237
LBN Legal business name Physician Services Corp Of Southern Illinois
DBA Doing business as St Marys Good Samaritan Medical Group
Authorized official Huntington, Richard
Entity Organization
Organization subpart 1 Yes
Enumeration date Jun 9th, 2005
Last updated Apr 2nd, 2009 - about 16 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1548264237 NPPES
Illinois MEDICAID 430653587005

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