| Ssm Health Medical Group | |
|
1441 W Broadway Centralia IL 62801-0001 | |
| (618) 532-9050 | |
| Not Available |
| Full Name | Ssm Health Medical Group |
|---|---|
| Speciality | Clinic/center - Rural Health |
| Location | 1441 W Broadway, Centralia, Illinois |
| Authorized Official Name and Position | Dee Evischi (VP FINANCE MEDICAL GROUP) |
| Authorized Official Contact | 6188991040 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ssm Health Medical Group 1411 W Broadway Centralia IL 62801-0001 Ph: (618) 532-9050 | Ssm Health Medical Group 1441 W Broadway Centralia IL 62801-0001 Ph: (618) 532-9050 |
| NPI Number | 1780688671 |
|---|---|
| Provider Enumeration Date | 06/08/2005 |
| Last Update Date | 08/26/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780688671 | NPI | - | NPPES |
| 1831101807 | Other | IL | NPI PSCSI GRP |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | 0002642 (Illinois) | Primary |
Tom Martin Md Sc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1050 Ml King Dr, Suite 104, Centralia, IL 62801 Phone: 618-532-6330 Fax: 618-532-7227 | |
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The Surgery Center Of Centralia Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1045 Martin Luther King Dr, Centralia, IL 62801 Phone: 618-532-3110 Fax: 618-532-3110 | |
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