Organization
MIDWEST ENDOSCOPY ASSOCIATES, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID RUSSELL HORACE (MANAGER)
(618) 973-8740
Entity
Organization
Contact information
Practice address
4224 LINCOLNSHIRE DR, MOUNT VERNON, IL 62864-2156
(314) 724-1348
Mailing address
325 W LINCOLN ST, BELLEVILLE, IL 62220-1921
(618) 235-2299
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
—
—
Other
Enumeration date
06/17/2021
Last updated
06/17/2021
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