Organization Name: | PHYSICIANS SURGERY CENTER, LLC |
NPI Number: | 1023297553 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | SHEFFIELD BOARDMAN (MEDICAL DIRECTOR) |
Mailing Address: | 2601 W Main St Carbondale |
State: | IL US |
Postal Code: | 629011031 |
Phone Number: | 6185495361 |
Fax Number: | |
NPI Enumeration Date: | 11/01/2007 |
NPI Last Update Date: | 10/08/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QA1903X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Ambulatory Surgical |
Taxonomy Definition: |