| Psychiatric Services Of Southern Illinois, Llc | |
|
2900 Frank Scott Pkwy W Suite 990 Belleville IL 62223-5000 | |
| (618) 236-6501 | |
| (618) 236-6551 |
| Full Name | Psychiatric Services Of Southern Illinois, Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 2900 Frank Scott Pkwy W, Belleville, Illinois |
| Authorized Official Name and Position | Jeffrey S Chalfant (PSYCHIATRIST) |
| Authorized Official Contact | 6182366501 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Psychiatric Services Of Southern Illinois, Llc 2900 Frank Scott Pkwy W Suite 990 Belleville IL 62223-5000 Ph: (618) 236-6501 | Psychiatric Services Of Southern Illinois, Llc 2900 Frank Scott Pkwy W Suite 990 Belleville IL 62223-5000 Ph: (618) 236-6501 |
| NPI Number | 1689991291 |
|---|---|
| Provider Enumeration Date | 04/23/2010 |
| Last Update Date | 08/05/2010 |
| Medicare PECOS PAC ID | 4082747597 |
|---|---|
| Medicare Enrollment ID | O20100804001058 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689991291 | NPI | - | NPPES |
| K25958 | Other | IL | MEDICARE ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Jeffrey S Chalfant |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1811935166 PECOS PAC ID: 9133136641 Enrollment ID: I20060308000449 |
| Provider Name | Julia Terese Ruckman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1356599971 PECOS PAC ID: 3779644786 Enrollment ID: I20081209000829 |
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