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SKIN CARE CENTER OF SOUTHERN IL LLC NPI 1669599841


NPI Information

NPI: 1669599841
Provider Name: SKIN CARE CENTER OF SOUTHERN IL LLC
Classification: Dermatology - 207ND0900X
Entity Type: Organization

Specialization: Dermatopathology

CLIA Number: 14D0932064

Address:
4107 S WATER TOWER PL
MOUNT VERNON, IL
ZIP 62864
Phone: (618) 244-0031
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SKIN CARE CENTER OF SOUTHERN IL LLC is a dermatopathology dermatology in Mount Vernon, IL. The provider is a dermatopathologist has the expertise to diagnose and monitor diseases of the skin including infectious, immunologic, degenerative and neoplastic diseases. This entails the examination and interpretation of specially prepared tissue sections, cellular scrapings and smears of skin lesions by means of routine and special (electron and fluorescent) microscopes. SKIN CARE CENTER OF SOUTHERN IL LLC NPI is 1669599841. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

4107 S WATER TOWER PL
MOUNT VERNON, IL
ZIP 62864-293
Phone: (618) 244-0031
Fax: (618) 244-0056

The provider's authorized official is George Thomas Nahass .
The authorized official title is Owner and has the following contact phone number (618) 244-0031.

The CLIA number assigned to this NPI record is 14D0932064 - physician office with a certificate type of Certificate of Compliance.

The enumeration date for this NPI number is 3/23/2007 and was last updated on 6/25/2013.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207ND0900XDermatologyDermatopathology036094700ILLINOISYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1CH5023OTHERILLINOISMEDICARE RAILROAD
2605050MEDICARE UPINILLINOIS
3152566974412MEDICAIDILLINOIS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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