Provider Demographics
NPI:1669709317
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:618-632-8211
Mailing Address - Street 1:1181 S STATE ROUTE 157
Mailing Address - Street 2:SUITE 200C
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62025-3710
Mailing Address - Country:US
Mailing Address - Phone:618-588-4100
Mailing Address - Fax:618-307-3283
Practice Address - Street 1:1181 S STATE ROUTE 157
Practice Address - Street 2:SUITE 200C
Practice Address - City:EDWARDSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62025-3710
Practice Address - Country:US
Practice Address - Phone:618-588-4100
Practice Address - Fax:618-307-3283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-17
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
IL6347670001Medicare NSC
IL207465Medicare PIN