Organization
AHS IL MEDICAL GROUP LLC
Active
Other names
Gateway Medical Group/ILSW Orthopedics
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JONATHAN BURKET (CHIEF COMPLIANCE OFFICER)
(818) 666-0602
Entity
Organization
Contact information
Practice address
3912 MARYVILLE RD, GRANITE CITY, IL 62040-4179
(618) 931-1335
Mailing address
3912 MARYVILLE RD, GRANITE CITY, IL 62040-4179
(618) 931-1335
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
10/12/2023
Last updated
10/12/2023
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