Provider Demographics
NPI:1265904486
Name:HSHS MEDICAL GROUP INC
Entity type:Organization
Organization Name:HSHS MEDICAL GROUP INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
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 1:3051 HOLLIS DR FL 2
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-7452
Mailing Address - Country:US
Mailing Address - Phone:217-492-9695
Mailing Address - Fax:217-492-9643
Practice Address - Street 1:900 W TEMPLE AVE STE 1500
Practice Address - Street 2:
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401-2121
Practice Address - Country:US
Practice Address - Phone:217-347-0458
Practice Address - Fax:217-342-2992
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HSHS MEDICAL GROUP INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-12-28
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health