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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