Organization
MARYVILLE MEDICAL SERVICES, LLC
Active
Organization
MARYVILLE MEDICAL SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEITH PAGE (CEO)
(618) 288-5711
Entity
Organization
Contact information
Practice address
6810 STATE ROUTE 162, SUITE 215, MARYVILLE, IL 62062-8501
(618) 288-5711
(618) 288-4088
Mailing address
6810 STATE ROUTE 162, SUITE 215, MARYVILLE, IL 62062-8501
(618) 288-5711
(618) 288-4088
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
—
—
367500000X
Certified Registered Nurse Anesthetist
Primary
—
—
Other
Enumeration date
07/04/2006
Last updated
06/23/2008
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