| NPI | 1740421536 |
|---|---|
| Doing Business As | ST MARYS GOOD SAMARITAN MEDICAL GROUP |
| Entity Type | Organization |
| Authorized Contact | TAMMY SIMONTON Mng 618-436-6267 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: IL 036116791) |
| Additional Taxonomies | 261QR1300X Clinic/Center, Rural Health (Licence: IL 002642) |
| Enumeration Date | 2009-03-09 |
| Last Update Date | 2009-03-12 |