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FAIRVIEW HEIGHTS MEDICAL GROUP SC NPI 1417140609


NPI Information

NPI: 1417140609
Provider Name: FAIRVIEW HEIGHTS MEDICAL GROUP SC

Doing Business As: ALTON UROLOGICAL ASSOCIATES EDWARDSVILLE

Classification: Urology - 208800000X
Entity Type: Organization
Address:
8 SUNSET HILLS PROFESSIONAL CTR
EDWARDSVILLE, IL
ZIP 62025
Phone: (618) 692-9828
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FAIRVIEW HEIGHTS MEDICAL GROUP SC is an urology in Edwardsville, IL. The provider is a urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures. FAIRVIEW HEIGHTS MEDICAL GROUP SC NPI is 1417140609. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Alton Urological Associates Edwardsville.

The provider's business location address is:

8 SUNSET HILLS PROFESSIONAL CTR
EDWARDSVILLE, IL
ZIP 62025-760
Phone: (618) 692-9828
Fax: (618) 692-7337

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 enumeration date for this NPI number is 8/22/2007 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
1208800000XUrologyYes

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

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