Organization
MSA ALLIANCE, LLC DBA-SOUTHERN ILLINOIS VASCULAR AND VEIN SURGERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES B. DAVIS (EXECUTIVE DIRECTOR)
(618) 257-4644
Entity
Organization
Contact information
Practice address
6810 STATE ROUTE 162, SUITE 100, MARYVILLE, IL 62062
(618) 334-2425
(618) 222-1039
Mailing address
4500 MEMORIAL DRIVE CREDENTIALING DEPT, MEMORIAL HOSPITAL MEDICAL AFFAIRS, BELLEVILLE, IL 62226
(618) 257-4644
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
—
—
Other
Enumeration date
05/20/2015
Last updated
05/20/2015
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