SKIN CARE CENTER OF SOUTHERN IL LLC


Address: 4107 S Water Tower Pl, Mount Vernon, IL 62864-6293
Phone: 6182440031

SKIN CARE CENTER OF SOUTHERN IL LLC (NPI# 1669599841) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1669599841
Entity Type Organization
Organization Name SKIN CARE CENTER OF SOUTHERN IL LLC
Practice Address 4107 S Water Tower Pl
Mount Vernon
IL 62864-6293
Practice Telephone 6182440031
Practice Fax Number 6182440056
Mailing Telephone 6182440031
Mailing Fax Number 6182440056
Enumeration Date 2007-03-23
Last Update Date 2013-06-25
Authorized Official Name DR. GEORGE THOMAS NAHASS (OWNER)
Authorized Official Telephone 6182440031
Authorized Official Credential M.D
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 207ND0900X Dermatology
Specialization: Dermatopathology
036094700 IL Allopathic & Osteopathic Physicians

Other Provider Identifier

State Issuer Identifier Type Code
IL 152566974412 05
IL MEDICARE RAILROAD CH5023 01

Office Location

Street Address 4107 S WATER TOWER PL
City MOUNT VERNON
State IL
Zip Code 62864-6293

Providers in the same location

NPI Name Taxonomy Address Enumeration
1215902986 George T Nahass Dermatology 4107 S Water Tower Pl, Mount Vernon, IL 62864-6293 2006-02-17
1578039707 Tina Hall Registered Nurse 4107 S Water Tower Pl, Mount Vernon, IL 62864-6293 2018-10-15
1467955179 United Skin Specialists Illinois Ltd, PC Dermatology 4107 S Water Tower Pl, Mount Vernon, IL 62864-6293 2018-03-09
1194225268 United Skin Specialists Illinois Ltd, PC Dermatology 4107 S Water Tower Pl, Mount Vernon, IL 62864-6293 2018-02-15
1083015689 Natalie Amason Dermatology 4107 S Water Tower Pl, Mount Vernon, IL 62864 2014-09-15
1669559290 Marilyn Stombaugh Physician Assistant 4107 S Water Tower Pl, Mount Vernon, IL 62864-6293 2006-11-01

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1619438892 Melissa Pryer Dietitian, Registered 2020 Broadway, Suite 1, Mt. Vernon, IL 62864 2019-03-28
1487145454 Chiropractic Wellness Center of Mt Vernon, LLC. Chiropractor 1009 S 42nd St Ste 5, Mount Vernon, IL 62864 2018-05-24
1851889208 Kimberly Tate Counselor 4110 North Water Place, Mt. Vernon, IL 62864 2018-05-01
1871907790 University Hematology Oncology Inc Specialist #11 Cusumano Professional Plaza, Mount Vernon, IL 62864 2014-06-18
1457771677 Dynamic Counseling and Consultation Services Social Worker 3600 S Water Tower Pl, Mt Vernon, IL 62864 2014-04-27
1619239431 Judith C Morgan Counselor 16338 N Illinois Hwy 37, Mount Vernon, IL 62864 2012-06-08
1073888624 James Brian Verges Counselor 16338 N. Illinois Hwy 37, Mount Vernon, IL 62864 2012-03-15
1720352271 Lucinda M. Holdren Counselor 16338 North Illinois Highway 37, Mount Vernon, IL 62864 2012-03-01
1780978627 Jamie M Orange Physical Therapy Assistant 19958 Fairfield Rd, Mt. Vernon, IL 62864 2011-06-08
1780978791 Wendy Marie Claytor Speech-Language Pathologist 600 E Il Hwy 15, Mount Vernon, IL 62864 2011-06-07
Find all providers in zip 62864

Taxonomy Information

Taxonomy Code 207ND0900X
Grouping Allopathic & Osteopathic Physicians
Classification Dermatology
Specialization Dermatopathology

Taxonomy Definition

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.
Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source]
- Additional Resources: American Board of Dermatology, 2007. http://www.abderm.org/; American Osteopathic Board of Dermatology, 2007. http://www.osteopathic.org/certification
- Board certification for Medical Doctors (MDs) is provided by the American Board of Dermatology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Dermatology.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1215902986 George T Nahass Dermatology 4107 S Water Tower Pl, Mount Vernon, IL 62864-6293 2006-02-17
1467955179 United Skin Specialists Illinois Ltd, PC Dermatology 4107 S Water Tower Pl, Mount Vernon, IL 62864-6293 2018-03-09
1194225268 United Skin Specialists Illinois Ltd, PC Dermatology 4107 S Water Tower Pl, Mount Vernon, IL 62864-6293 2018-02-15

Providers in the same taxonomy and state

NPI Name Taxonomy Address Enumeration
1376866897 Physicians Dermpath Laboratory Dermatology 1420 N. Renaissance Dr., Suite 204, Park Ridge, IL 60068-1330 2010-03-11
1417075961 Asanee Lertsburapa Dermatology 708 Midwest Club Park Parkway, Oak Brook, IL 60523 2007-03-26
1861404279 Nathaniel Morgan Dermatology 11157 S Halsted St, Chicago, IL 60628-3910 2006-08-13
1467476457 Jeffrey Berti Dermatology 6825 Kingery Hwy, Willowbrook, IL 60527-5154 2006-07-26
1023040573 Thomas L. Fisher, M.d., S.c. Dermatology 47 W Polk St Lbby G1, Chicago, IL 60605-2087 2006-07-07
1073041455 Sepideh Asadbeigi Dermatology 676 N Saint Clair St Ste 1600, Chicago, IL 60611-2997 2017-05-30
1548517949 Michael Sidiropoulos Dermatology 676 N Saint Clair St Ste 1600, Chicago, IL 60611-2997 2012-08-06
1437404951 Christina G Steil Dermatology Ltd Dermatology 40 S Clay St, #210e, Hinsdale, IL 60521-3257 2012-07-20
1245490382 Tesfu Hailu Dermatology 4909 N Glen Park Place Rd, Peoria, IL 61614-4676 2008-06-12
1528235371 Ana M Eng Md Sc Dermatology 103 N Haven Rd, Ste 7, Elmhurst, IL 60126-2923 2008-05-12
Find all providers with the same taxonomy

Competitor

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City MOUNT VERNON
Zip Code 62864

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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