| NPI | 1174702708 |
|---|---|
| Doing Business As | THE SPORTS & PHYSICAL MEDICINE CLINIC @ ST. MARY'S |
| Entity Type | Organization |
| Authorized Contact | MARK D EVARD VP Of Revenue Cycle 217-492-9651 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085-003034) |
| Enumeration Date | 2007-10-31 |
| Last Update Date | 2023-09-19 |