Organization Name: | MSA ALLIANCE, LLC DBA-SOUTHERN ILLINOIS VASCULAR AND VEIN SURGERY |
NPI Number: | 1003295213 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JAMES B. DAVIS (EXECUTIVE DIRECTOR) |
Mailing Address: | 6810 State Route 162 Suite 100 Maryville |
State: | IL US |
Postal Code: | 62062 |
Phone Number: | 6183342425 |
Fax Number: | 6182221039 |
NPI Enumeration Date: | 05/20/2015 |
NPI Last Update Date: | 05/20/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 2086S0129X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | Surgery |
Taxonomy Specialization: | Vascular Surgery |
Taxonomy Definition: | A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart. |