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).
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 |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 207ND0900X |
Dermatology Specialization: Dermatopathology |
036094700 | IL | Allopathic & Osteopathic Physicians |
State | Issuer | Identifier | Type Code |
---|---|---|---|
IL | 152566974412 | 05 | |
IL | MEDICARE RAILROAD | CH5023 | 01 |
Street Address |
4107 S WATER TOWER PL |
City | MOUNT VERNON |
State | IL |
Zip Code | 62864-6293 |
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 |
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 Code | 207ND0900X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Dermatology |
Specialization | Dermatopathology |
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. |
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 |
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 |
City | MOUNT VERNON |
Zip Code | 62864 |
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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.