Basic Information
| Provider Information | |||||||||
| NPI: | 1962644807 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HSHS MEDICAL GROUP INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3051 HOLLIS DR | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 627047450 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2175235406 | ||||||||
| FaxNumber: | 2174929643 | ||||||||
| Practice Location | |||||||||
| Address1: | 3051 HOLLIS DR | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 627047450 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2175235406 | ||||||||
| FaxNumber: | 2174929643 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/24/2009 | ||||||||
| LastUpdateDate: | 08/17/2022 | ||||||||
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| AuthorizedOfficialLastName: | WATSON | ||||||||
| AuthorizedOfficialFirstName: | ANDREW | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 2174925806 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 08/17/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty |
No ID Information.