Organization
MARYVILLE WOMENS CENTER SSR PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY N SANFORD M.D. (OWNER)
(618) 288-2970
Entity
Organization
Contact information
Practice address
2016 VADALABENE DR, SUITE B, MARYVILLE, IL 62062-6901
(618) 288-2970
(618) 288-3572
Mailing address
2016 VADALABENE DR, SUITE B, MARYVILLE, IL 62062-6901
(618) 288-2970
(618) 288-3572
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
367A00000X
Advanced Practice Midwife
—
—
Other
Enumeration date
02/05/2016
Last updated
02/05/2016
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