Organization
MARYVILLE RADIOLOGY GROUP, LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TERRY BURK MD (PRESIDENT)
(618) 288-5711
Entity
Organization
Contact information
Practice address
ILLINOIS ROUTE 162, ANDERSON HOSPITAL DEPT OF RADIOLOGY, MARYVILLE, IL 62062
(618) 288-5711
Mailing address
PO BOX 78130, SAINT LOUIS, MO 63178-8130
(309) 363-4660
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
149856
BCBS
MO
01
—
6010052
BCBS
IL
01
—
99693
GHP
—
Enumeration date
07/18/2006
Last updated
02/12/2020
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