Provider Demographics
NPI:1235467606
Name:ASSOCIATED PHYSICIANS GROUP LTD
Entity Type:Organization
Organization Name:ASSOCIATED PHYSICIANS GROUP LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:S
Authorized Official - Last Name:VICK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:618-628-8211
Mailing Address - Street 1:12 WOLF CREEK DRIVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SWANSEA
Mailing Address - State:IL
Mailing Address - Zip Code:62226
Mailing Address - Country:US
Mailing Address - Phone:618-239-9910
Mailing Address - Fax:618-239-9795
Practice Address - Street 1:12 WOLF CREEK DR
Practice Address - Street 2:SUITE 200
Practice Address - City:SWANSEA
Practice Address - State:IL
Practice Address - Zip Code:62226-2314
Practice Address - Country:US
Practice Address - Phone:618-239-9910
Practice Address - Fax:618-239-9795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-24
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038007328174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL207465Medicare PIN
IL6347670002Medicare NSC