# MSA ALLIANCE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Southern Illinois Vascular and Vein Surgery
- **Organization subpart:** No

## Provider details

- **NPI number:** 1104269091
- **Authorized official:** MR. JAMES B. DAVIS (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (618) 257-4644

## Contact information

- **Practice address:** 1245 S MILL ST, NASHVILLE, IL 62263-2004
- **Practice address phone:** (618) 327-8119
- **Practice address fax:** (618) 327-8141
- **Mailing address:** 4500 MEMORIAL DR, MEDICAL AFFAIRS OFFICE CREDENTIALING DEPARTMENT, BELLEVILLE, IL 62226-5360
- **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:** 04/10/2013
- **Last updated:** 04/10/2013