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Organization
MEMORIAL MEDICAL GROUP, LLC
Active
Organization
MEMORIAL MEDICAL GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAMES B. DAVIS (EXECUTIVE DIRECTOR)
(618) 257-6302
Entity
Organization
Contact information
Practice address
4550 MEMORIAL DR, STE. 340, BELLEVILLE, IL 62226-5372
(618) 257-6302
(618) 257-4838
Mailing address
4550 MEMORIAL DR, STE. 340, BELLEVILLE, IL 62226-5372
(618) 257-6302
(618) 257-4838
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
—
—
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
207RC0000X
Cardiovascular Disease Physician
—
—
207RC0001X
Clinical Cardiac Electrophysiology Physician
—
—
207RG0100X
Gastroenterology Physician
—
—
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
—
—
207RP1001X
Pulmonary Disease Physician
—
—
207RS0010X
Sports Medicine (Internal Medicine) Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
207X00000X
Orthopaedic Surgery Physician
—
—
208100000X
Physical Medicine & Rehabilitation Physician
—
—
2086S0122X
Plastic and Reconstructive Surgery Physician
—
—
2086S0129X
Vascular Surgery Physician
—
—
208800000X
Urology Physician
—
—
Other
Enumeration date
12/05/2012
Last updated
12/05/2012
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