Fairview Heights Medical Group Sc

NPI #1942344981 in Alton, Illinois

Provider Information

NPI Number: 1942344981
Entity Type: Organization
Organization Name: Fairview Heights Medical Group Sc
Primary Specialty: Clinic/Center
Enumeration Date: Feb 15, 2007
Last Updated: Jan 7, 2008

Practice Location

Address: 1 MEMORIAL DR
Address 2: 1ST FLOOR
City: Alton
State: Illinois
ZIP Code: 62002-6722
Phone: (618) 433-7066

Authorized Official

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

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Clinic/Center	261Q00000X	Primary

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