| St Marys Good Samaritan Medical Group | |
|
8 Cusumano Professional Plaza Dr Mount Vernon IL 62864-6736 | |
| (618) 242-7819 | |
| Not Available |
| Full Name | St Marys Good Samaritan Medical Group |
|---|---|
| Speciality | Clinic/center - Rural Health |
| Location | 8 Cusumano Professional Plaza Dr, Mount Vernon, Illinois |
| Authorized Official Name and Position | Richard Huntington (VP FINANCIAL DEVELOPMENT) |
| Authorized Official Contact | 6182412204 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| St Marys Good Samaritan Medical Group 413 Main St Mount Vernon IL 62864 Ph: (618) 532-9350 | St Marys Good Samaritan Medical Group 8 Cusumano Professional Plaza Dr Mount Vernon IL 62864-6736 Ph: (618) 242-7819 |
| NPI Number | 1548264237 |
|---|---|
| Provider Enumeration Date | 06/09/2005 |
| Last Update Date | 04/02/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548264237 | NPI | - | NPPES |
| 430653587005 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | 0004705 (Illinois) | Primary |
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