# FAIRVIEW HEIGHTS MEDICAL GROUP SC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Alton Surgery
- **Organization subpart:** No

## Provider details

- **NPI number:** 1780740936
- **Authorized official:** RAYMOND P DAVIDSON II MD (PRESIDENT)
- **Authorized official phone:** (314) 286-2028

## Contact information

- **Practice address:** 2 MEMORIAL DR, SUITE 105, ALTON, IL 62002-6723
- **Practice address phone:** (618) 462-3191
- **Mailing address:** 670 MASON RIDGE CENTER DR, SUITE 300, SAINT LOUIS, MO 63141-8573
- **Mailing address phone:** (314) 996-7644
- **Mailing address fax:** (314) 966-7658

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 12/29/2006
- **Last updated:** 01/04/2008