Fairview Heights Medical Group Sc

NPI #1780715441 in Bethalto, Illinois

Provider Information

NPI Number: 1780715441
Entity Type: Organization
Organization Name: Fairview Heights Medical Group Sc
Primary Specialty: Family Medicine
Enumeration Date: Mar 7, 2007
Last Updated: Jan 7, 2008

Practice Location

Address: 155 E BETHALTO DR
City: Bethalto
State: Illinois
ZIP Code: 62010-1801
Phone: (618) 377-8961

Authorized Official

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

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Family Medicine	207Q00000X	Primary

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