Organization
MSA ALLIANCE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES B DAVIS (EXECUTIVE DIRECTOR)
(618) 257-4644
Entity
Organization
Contact information
Practice address
1404 CROSS ST, SUITE 2114, SHILOH, IL 62269-2988
(618) 233-2220
Mailing address
MEMORIAL HOSPITAL MEDICAL AFFAIRS, 4500 MEMORIAL DRIVE CREDENTIALING DEPARTMENT, BELLEVILLE, IL 62226
(618) 257-4644
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
036125732
IL
Other
Enumeration date
09/02/2016
Last updated
09/02/2016
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