Provider Demographics
NPI:1821357807
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:DO
Authorized Official - Phone:618-628-8211
Mailing Address - Street 1:916 TALON DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:O FALLEN
Mailing Address - State:IL
Mailing Address - Zip Code:62269-1848
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:20 PROFESSIONAL PARK DR
Practice Address - Street 2:SUITE A
Practice Address - City:MARYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62062-5830
Practice Address - Country:US
Practice Address - Phone:618-205-3655
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-10
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1811940893OtherBCBS
IL1811940893OtherTRICARE
IL1811940893OtherUHC
IL207465Medicare PIN