Fairview Heights Medical Group Sc

NPI #1164553483 in Alton, Illinois

Provider Information

NPI Number: 1164553483
Entity Type: Organization
Organization Name: Fairview Heights Medical Group Sc
Primary Specialty: Internal Medicine
Enumeration Date: Mar 8, 2007
Last Updated: Jan 4, 2008

Practice Location

Address: 2 MEMORIAL DR
Address 2: SUITE 220
City: Alton
State: Illinois
ZIP Code: 62002-6723
Phone: (618) 462-3191

Authorized Official

Name: RAYMOND P DAVIDSON II, MD
Title: PRESIDENT
Phone: (314) 286-2028

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Internal Medicine	207R00000X	Primary

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