Basic Information
| Provider Information | |||||||||
| NPI: | 1669709317 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ASSOCIATED PHYSICIANS GROUP LTD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1181 S STATE ROUTE 157 | ||||||||
| Address2: | SUITE 200C | ||||||||
| City: | EDWARDSVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 620253710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6185884100 | ||||||||
| FaxNumber: | 6183073283 | ||||||||
| Practice Location | |||||||||
| Address1: | 1181 S STATE ROUTE 157 | ||||||||
| Address2: | SUITE 200C | ||||||||
| City: | EDWARDSVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 620253710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6185884100 | ||||||||
| FaxNumber: | 6183073283 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/17/2009 | ||||||||
| LastUpdateDate: | 07/08/2010 | ||||||||
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| AuthorizedOfficialLastName: | VICK | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6186328211 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | D.C. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 038007328 | IL | Y | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.