Organization Name: | FAIRVIEW HEIGHTS MEDICAL GROUP SC |
NPI Number: | 1114110350 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | RAYMOND P DAVIDSON (PRESIDENT) |
Mailing Address: | 400 N Caldwell St Staunton |
State: | IL US |
Postal Code: | 620881423 |
Phone Number: | 6186352200 |
Fax Number: | 6186354244 |
NPI Enumeration Date: | 08/21/2007 |
NPI Last Update Date: | 01/07/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 207RC0000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | Internal Medicine |
Taxonomy Specialization: | Cardiovascular Disease |
Taxonomy Definition: | An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms. |