Organization
GENERAL AND VASCULAR SURGICAL ASSOC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES ALLEN LANE M.D. (PRESIDENT)
(618) 288-3616
Entity
Organization
Contact information
Practice address
6810 STATE ROUTE 162, SUITE 105, MARYVILLE, IL 62062-8501
(618) 288-3616
(618) 288-3647
Mailing address
6810 STATE ROUTE 162, SUITE 105, MARYVILLE, IL 62062-8501
(618) 288-3616
(618) 288-3647
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
IL
Other
Enumeration date
11/29/2006
Last updated
08/22/2020
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