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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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