FAIRVIEW HEIGHTS MEDICAL GROUP SC NPI 1134285380

NPI Information

NPI: 1134285380
Provider Name: FAIRVIEW HEIGHTS MEDICAL GROUP SC

Doing Business As: FAMILY PHYSICIANS OF BETHALTO

Classification: Clinic/Center - 261QP2300X
Entity Type: Organization

Specialization: Primary Care

Address:
155 E BETHALTO DR
BETHALTO, IL
ZIP 62010
Phone: (618) 377-8961
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FAIRVIEW HEIGHTS MEDICAL GROUP SC is a primary care clinic center in Bethalto, IL. FAIRVIEW HEIGHTS MEDICAL GROUP SC NPI is 1134285380. The provider is registered as an organization entity type.
The provider Is Doing Business As Family Physicians Of Bethalto.

The provider's business location address is:

155 E BETHALTO DR
BETHALTO, IL
ZIP 62010-801
Phone: (618) 377-8961
Fax: (618) 377-8962

The provider's authorized official is Raymond P Davidson .
The authorized official title is President and has the following contact phone number (314) 286-2028.

The CLIA number assigned to this NPI record is 14D1012384 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 12/29/2006 and was last updated on 1/7/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QP2300X	Clinic/Center	Primary Care			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	413610	MEDICARE ID-TYPE UNSPECIFIED	ILLINOIS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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