# MSA ALLIANCE, LLC

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

## Provider details

- **NPI number:** 1093258154
- **Authorized official:** JAMES B DAVIS (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (618) 257-4644

## Contact information

- **Practice address:** 2 MEMORIAL DR, SUITE 201, ALTON, IL 62002-6723
- **Practice address phone:** (618) 222-1020
- **Practice address fax:** (618) 222-1039
- **Mailing address:** 4500 MEMORIAL DRIVE, MEMORIAL HOSPITAL MEDICAL AFFAIRS CREDENTIALING DEPT, BELLEVILLE, IL 62226
- **Mailing address phone:** (618) 257-4644
- **Mailing address fax:** (618) 257-6946

## Taxonomy

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

## Other

- **Enumeration date:** 11/22/2016
- **Last updated:** 11/22/2016