# MARYVILLE PHYSICIANS SERVICES INC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** MARYVILLE PHYSICIANS SERVICES INC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1124261219
- **Legal business name:** MARYVILLE PHYSICIANS SERVICES INC
- **Authorized official:** KEITH PAGE (PRESIDENT)
- **Authorized official phone:** (618) 288-5711

## Contact information

- **Practice address:** 6812 STATE ROUTE 162, SUITE 123, MARYVILLE, IL 62062-8553
- **Practice address phone:** (618) 288-9460
- **Practice address fax:** (618) 288-9461
- **Mailing address:** 1836 LACKLAND HILL PKWY, SAINT LOUIS, MO 63146-3572
- **Mailing address phone:** (314) 989-0300

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | Yes |
| 207X00000X | Orthopaedic Surgery Physician | — | — | Yes |

## Other

- **Enumeration date:** 04/20/2009
- **Last updated:** 02/12/2010