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
2016 VADALABENE DR, SUITE B, MARYVILLE, IL 62062-6901
(618) 222-1020
(618) 222-1039
Mailing address
4500 MEMORIAL DRIVE, MEMORIAL HOSPITAL MEDICAL AFFAIRS CREDENTIALING DEPT, BELLEVILLE, IL 62226
(618) 257-4644
(618) 257-6946
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
—
—
Other
Enumeration date
11/22/2016
Last updated
11/22/2016
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