# FAIRVIEW HEIGHTS MEDICAL GROUP SC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Alton Wound Care Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1942344981
- **Authorized official:** RAYMOND P DAVIDSON II MD (PRESIDENT)
- **Authorized official phone:** (314) 286-2028

## Contact information

- **Practice address:** 1 MEMORIAL DR, 1ST FLOOR, ALTON, IL 62002-6722
- **Practice address phone:** (618) 433-7066
- **Mailing address:** 670 MASON RIDGE CENTER DR, SUITE 300, SAINT LOUIS, MO 63141-8573
- **Mailing address phone:** (314) 996-7644
- **Mailing address fax:** (314) 996-7658

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 02/15/2007
- **Last updated:** 01/07/2008