Organization
GRANITE CITY PHYSICIANS CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GARY NEWSOME (VICE PRESIDENT)
(618) 451-1500
Entity
Organization
Contact information
Practice address
2044 MADISON AVE, SUITE 15, GRANITE CITY, IL 62040-4641
(618) 451-1500
Mailing address
2044 MADISON AVE, SUITE 15, GRANITE CITY, IL 62040-4641
(618) 451-1500
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Enumeration date
03/26/2007
Last updated
08/22/2020
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