| Organization Name: | MEDICAL SERVICE CORPORATION SC |
| NPI Number: | 1093150567 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | AGNES WILSON (RN) |
| Mailing Address: | 104 W 6th St Ste 206 Streator |
| State: | IL US |
| Postal Code: | 613642864 |
| Phone Number: | 8152521805 |
| Fax Number: | 8156630103 |
| NPI Enumeration Date: | 05/09/2013 |
| NPI Last Update Date: | 11/13/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |