# MSA ALLIANCE, LLC DBA-SOUTHERN ILLINOIS VASCULAR AND VEIN SURGERY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1003295213
- **Authorized official:** JAMES B. DAVIS (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (618) 257-4644

## Contact information

- **Practice address:** 6810 STATE ROUTE 162, SUITE 100, MARYVILLE, IL 62062
- **Practice address phone:** (618) 334-2425
- **Practice address fax:** (618) 222-1039
- **Mailing address:** 4500 MEMORIAL DRIVE CREDENTIALING DEPT, MEMORIAL HOSPITAL MEDICAL AFFAIRS, BELLEVILLE, IL 62226
- **Mailing address phone:** (618) 257-4644

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2086S0129X | Vascular Surgery Physician | — | NULL | Yes |
| 2086S0129X | Vascular Surgery Physician | — | — | Yes |

## Other

- **Enumeration date:** 05/20/2015
- **Last updated:** 05/20/2015