Organization
MSA ALLIANCE, LLC
Active
Parent organization
MSA ALLIANCE, LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
MSA ALLIANCE, LLC
Authorized official
JAMES B. DAVIS (EXECUTIVE DIRECTOR)
(618) 257-4644
Entity
Organization
Contact information
Practice address
4700 MEMORIAL DRIVE, STE. 200, BELLEVILLE, IL 62226
(618) 222-9192
(618) 222-9234
Mailing address
4500 MEMORIAL DR, MEDICAL AFFAIRS CREDENTIALING DEPARTMENT, BELLEVILLE, IL 62226-5360
(618) 257-4644
(618) 257-6946
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
—
—
208100000X
Physical Medicine & Rehabilitation Physician
—
—
Other
Enumeration date
05/26/2011
Last updated
09/12/2013
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