Organization
GRANITE CITY CLINIC CORP
Active
Organization
GRANITE CITY CLINIC CORP
Active
Other names
Granite City Anesthesia
Organization subpart
No
Provider details
NPI number
Authorized official
GARY NEWSOME (VP)
(615) 465-7000
Entity
Organization
Contact information
Practice address
2100 MADISON AVE, GRANITE CITY, IL 62040-4701
(618) 798-3000
Mailing address
P O BOX 503734, SAINT LOUIS, MO 63150-0001
(660) 826-5960
(660) 826-4852
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
—
—
367500000X
Certified Registered Nurse Anesthetist
Primary
—
—
Other
Enumeration date
12/19/2005
Last updated
07/30/2007
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