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Organization
SAINT ANTHONY'S PHYSICIAN GROUP
Active
Organization
SAINT ANTHONY'S PHYSICIAN GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL L NELSON (EXECUTIVE VICE-PRESIDENT/CFO)
(618) 463-5616
Entity
Organization
Contact information
Practice address
2 SAINT ANTHONYS WAY, SUITE 205, ALTON, IL 62002-4569
(618) 462-2222
(618) 463-5004
Mailing address
2 SAINT ANTHONYS WAY STE 205, PO BOX 1083, ALTON, IL 62002-4569
(618) 462-2222
(618) 462-1150
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
207RG0100X
Gastroenterology Physician
—
—
207Y00000X
Otolaryngology Physician
—
—
2085R0001X
Radiation Oncology Physician
—
—
208600000X
Surgery Physician
—
—
213ES0103X
Foot & Ankle Surgery Podiatrist
—
—
363AM0700X
Medical Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0006021087
BLUE SHIELD
IL
Enumeration date
08/23/2006
Last updated
12/23/2014
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