PHYSICIAN SERVICES CORP OF SOUTHERN ILLINOIS (NPI# 1619109543) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1619109543 |
| Entity Type | Organization |
| Organization Name | PHYSICIAN SERVICES CORP OF SOUTHERN ILLINOIS |
| Other Organization Name | ST MARYS GOOD SAMARITAN MEDICAL GROUP |
| Practice Address |
1250 W Whittaker St Salem IL 62881-1917 |
| Mailing Address |
413 Main St Mount Vernon IL 62864-3649 |
| Practice Telephone | 6185323950 |
| Practice Fax Number | 6185329365 |
| Mailing Telephone | 6185323950 |
| Mailing Fax Number | 6185329365 |
| Enumeration Date | 2009-08-11 |
| Last Update Date | 2009-08-11 |
| Authorized Official Name | MR. RICHARD HUNTINGTON (VP FINANCIAL DEVELOPMENT) |
| Authorized Official Telephone | 6182412204 |
| Is Organization Subpart | Y |
| Parent Organization Name | PHYSICAN SEVICES CORP OF SOUTHERN ILLINOIS |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QR1300X |
Clinic/Center Specialization: Rural Health |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| St Marys Good samaritan Medical Group | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548264237 | Physician Services Corp of Southern Illinois | Clinic/Center | 8 Cusumano Professional Plaza Dr, Mount Vernon, IL 62864-6736 | 2005-06-09 |
| 1740421536 | Physician Services Corp of Southern Illinois | Clinic/Center | 430 N Pleasant Ave, Centralia, IL 62801-3006 | 2009-03-09 |
| Street Address |
1250 W WHITTAKER ST |
| City | SALEM |
| State | IL |
| Zip Code | 62881-1917 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952399511 | Roger Young | Nurse Practitioner | 1250 W Whittaker St, Salem, IL 62881-1917 | 2005-10-07 |
| 1619024361 | Keith Shaw | Physical Medicine & Rehabilitation | 1250 W Whittaker St, Salem, IL 62881-1917 | 2007-01-04 |
| 1497842785 | Michael Smith | Physical Medicine & Rehabilitation | 1250 W Whittaker St, Salem, IL 62881-1917 | 2006-10-06 |
| 1841390846 | Trisha Bass | Physical Medicine & Rehabilitation | 1250 W Whittaker St, Salem, IL 62881-1917 | 2006-09-22 |
| 1881648194 | Mary K Piper | Family Medicine | 1250 W Whittaker St, Salem, IL 62881-1917 | 2006-05-20 |
| 1255394797 | Tamara Dee Foltz | Nurse Practitioner | 1250 W Whittaker St, Salem, IL 62881-1917 | 2006-04-07 |
| 1316909021 | Mahvish Zahoor | Family Medicine | 1250 W Whittaker St, Salem, IL 62881-1917 | 2006-04-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447776026 | Heather Krajefska | Speech-Language Pathologist | Franklin Park School, 1325 N Franklin, Salem, IL 62881 | 2017-08-16 |
| 1629510581 | Heidi V. Thompson | Nurse Practitioner | 1250 W. Whittaker, Salem, IL 62881 | 2016-11-09 |
| 1548664170 | Catherine Durbin | Nurse Practitioner | 518 South Broadway, Salem, IL 62881 | 2014-10-10 |
| 1770718439 | Community Resource Center, Inc | Community/Behavioral Health | 315 Westgate, Salem, IL 62881 | 2009-05-26 |
| 1932377652 | Community Resource Center Inc | Clinic/Center | 315 Westgate Ave, Salem, IL 62881 | 2008-02-15 |
| 1245408053 | The Manor At Salem Woods, L.p. | Assisted Living Facility | 441 S. Hotze Rd., Salem, IL 62881 | 2008-02-14 |
| 1366610321 | Penta Group Inc. | Non-emergency Medical Transport (VAN) | 300 Schoonover Drive, Salem, IL 62881 | 2008-02-13 |
| 1326192808 | Alan D Montgomery | Optometrist | 400 North Broadway, Salem, IL 62881 | 2007-01-22 |
| 1669539979 | Knevitt Inc | Ambulance | 3340 Selmaville Rd, Salem, IL 62881 | 2007-01-03 |
| 1447314737 | Gautam Jha | Internal Medicine | 1325 W. Whittaker, Suite D, Salem, IL 62881 | 2006-12-20 |
| Find all providers in zip 62881 | ||||
| Taxonomy Code | 261QR1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rural Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679600936 | Ozarks Medical Center | Clinic/Center | 172 Hwy 62 East, Suite 1, Salem, AR 72576 | 2007-02-27 |
| 1821089657 | Salem Memorial Hospital | Clinic/Center | 35629 Highway 72 Bldg II, Salem, MO 65560-7217 | 2005-11-01 |
| 1639174568 | Avera Queen of Peace | Clinic/Center | 741 S Hill St, Salem, SD 57058-8761 | 2005-06-16 |
| 1649830472 | Salem Township Hospital | Clinic/Center | 1321 W Whittaker St, Salem, IL 62881-2013 | 2019-06-14 |
| 1316411655 | Crittenden Community Hospital LLC | Clinic/Center | 117 E Main St, Salem, KY 42078-9998 | 2019-01-21 |
| 1922345800 | Salem Memorial Hospital | Clinic/Center | 35629 Highway 72, Building 1, Salem, MO 65560-7217 | 2013-01-11 |
| 1194077701 | Pcrmc Medical Group, Inc | Clinic/Center | 1415 W Scenic Rivers Blvd, Salem, MO 65560-2840 | 2012-10-05 |
| 1023326436 | Lifeline Homecare of Salem LLC | Clinic/Center | 503 E Main St, Salem, KY 42078-8033 | 2010-09-20 |
| 1619201829 | Avera Queen of Peace | Clinic/Center | 741 S Hill St, Salem, SD 57058-8761 | 2009-09-22 |
| 1821243981 | Salem Memorial Hospital | Clinic/Center | 35629 Hwy 72, Bld. 3, Salem, MO 65560-0719 | 2008-11-17 |
| Find all providers in SALEM | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.