Organization
MSA ALLIANCE, LLC
Active
Other names
Southern Illinois Vascular and Vein Surgery
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAMES B. DAVIS (EXECUTIVE DIRECTOR)
(618) 257-4644
Entity
Organization
Contact information
Practice address
1245 S MILL ST, NASHVILLE, IL 62263-2004
(618) 327-8119
(618) 327-8141
Mailing address
4500 MEMORIAL DR, MEDICAL AFFAIRS OFFICE CREDENTIALING DEPARTMENT, BELLEVILLE, IL 62226-5360
(618) 257-4644
(618) 257-6946
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
—
—
Other
Enumeration date
04/10/2013
Last updated
04/10/2013
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