Provider Demographics
NPI:1417906959
Name:HSHS MEDICAL GROUP INC
Entity Type:Organization
Organization Name:HSHS MEDICAL GROUP INC
Other - Org Name:HSHS MEDICAL GROUP FAMILY MEDICINE - HILLSBORO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-492-5806
Mailing Address - Street 1:1220 E. TREMONT
Mailing Address - Street 2:SUITE A
Mailing Address - City:HILLSBORO
Mailing Address - State:IL
Mailing Address - Zip Code:62049-1509
Mailing Address - Country:US
Mailing Address - Phone:217-532-9471
Mailing Address - Fax:217-532-9476
Practice Address - Street 1:1220 E. TREMONT
Practice Address - Street 2:SUITE A
Practice Address - City:HILLSBORO
Practice Address - State:IL
Practice Address - Zip Code:62049-1509
Practice Address - Country:US
Practice Address - Phone:217-532-9471
Practice Address - Fax:217-532-9476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36046053261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL371201757001Medicaid
IL0472590001Medicare NSC
IL148917Medicare Oscar/Certification
231120Medicare PIN