Organization
ALTON MULTISPECIALISTS, LTD.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SHERRI R HENSON (EXECUTIVE DIRECTOR)
(618) 463-8634
Entity
Organization
Contact information
Practice address
1 PROFESSIONAL DR, ALTON, IL 62002-5068
(618) 463-8500
(618) 474-0130
Mailing address
1 PROFESSIONAL DR, ALTON, IL 62002-5068
(618) 463-8500
(618) 474-0130
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
036-071248
IL
261QR0206X
Mammography Clinic/Center
Primary
100867
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0317160001
MEDICARE DME SUPPLIER
—
01
—
06015403
BLUE CROSS/BLUE SHIELD
IL
01
—
207219
PTAN
IL
01
—
687340
PTAN
IL
Enumeration date
08/31/2006
Last updated
08/30/2016
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