FAIRVIEW HEIGHTS MEDICAL GROUP SC (NPI# 1487847638) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1487847638 |
| Entity Type | Organization |
| Organization Name | FAIRVIEW HEIGHTS MEDICAL GROUP SC |
| Other Organization Name | ALTON UROLOGICAL ASSOCIATES GRANITE CITY |
| Practice Address |
2044 Madison Ave Suite 15 Granite City IL 62040-4641 |
| Mailing Address |
670 Mason Ridge Center Dr Suite 300 Saint Louis MO 63141-8573 |
| Practice Telephone | 6184511500 |
| Practice Fax Number | 6184519498 |
| Mailing Telephone | 3149967644 |
| Mailing Fax Number | 3149967658 |
| Enumeration Date | 2007-08-21 |
| Last Update Date | 2008-01-07 |
| Authorized Official Name | RAYMOND P DAVIDSON II (PRESIDENT) |
| Authorized Official Telephone | 3142862028 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208800000X | Urology | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Alton Urological Associates Granite City | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073022000 | Fairview Heights Medical Group Sc | Clinic/Center | 670 Mason Ridge Center Dr Ste 300, Saint Louis, MO 63141-8573 | 2017-09-21 |
| 1538341094 | Fairview Heights Medical Group Sc | Urology | 2246 S State Route 157, Ste. 200, Glen Carbon, IL 62034-1717 | 2007-11-27 |
| 1487787818 | Fairview Heights Medical Group Sc | Pediatrics | 11th and Broadway, 4th Floor, Quincy, IL 62301 | 2007-03-14 |
| 1326171158 | Fairview Heights Medical Group Sc | Pediatrics | 4230 Lincolnshire Dr Ste A, Mount Vernon, IL 62864-2189 | 2007-03-13 |
| 1710168166 | Fairview Heights Medical Group Sc | Hospitalist | 1 Memorial Dr, Suite 2-101, Alton, IL 62002-6722 | 2007-11-14 |
| 1417140609 | Fairview Heights Medical Group Sc | Urology | 8 Sunset Hills Professional Ctr, Edwardsville, IL 62025-3760 | 2007-08-22 |
| 1114110350 | Fairview Heights Medical Group Sc | Internal Medicine | 400 N Caldwell St, Staunton, IL 62088-1423 | 2007-08-21 |
| 1538292370 | Fairview Heights Medical Group Sc | Pediatrics | 2601 W Main St, Carbondale, IL 62901-1031 | 2007-03-13 |
| 1528199718 | Fairview Heights Medical Group Sc | Family Medicine | 230 Regional Dr, Alton, IL 62002-5942 | 2007-03-08 |
| 1164553483 | Fairview Heights Medical Group Sc | Internal Medicine | 2 Memorial Dr, Suite 220, Alton, IL 62002-6723 | 2007-03-08 |
| Street Address |
2044 MADISON AVE SUITE 15 |
| City | GRANITE CITY |
| State | IL |
| Zip Code | 62040-4641 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851383301 | Michael C Adams | Internal Medicine | 2044 Madison Ave, Suite 15, Granite City, IL 62040-4641 | 2005-08-19 |
| 1316366594 | Biomedical Imaging, LLC | Physiological Laboratory | 2044 Madison Ave, Suite 28, Granite City, IL 62040-4641 | 2014-04-15 |
| 1922233576 | Elizabeth Patricia Mincy | Nurse Practitioner | 2044 Madison Ave, Suite 15, Granite City, IL 62040-4641 | 2009-05-27 |
| 1528222437 | Paul Joseph Pace | Surgery | 2044 Madison Ave, Suite 27, Granite City, IL 62040-4641 | 2008-07-10 |
| 1023292000 | Granite City Orthopedic Physicians Company LLC | Durable Medical Equipment & Medical Supplies | 2044 Madison Ave, Granite City, IL 62040-4641 | 2007-12-26 |
| 1508079328 | Debra Ann Clark | Registered Nurse | 2044 Madison Ave, Suite G7, Granite City, IL 62040-4641 | 2007-05-08 |
| 1508983214 | Granite City Physicians Corp | Clinical Medical Laboratory | 2044 Madison Ave, Suite 15, Granite City, IL 62040-4641 | 2007-03-26 |
| 1184741142 | Bijoy Hegde Md, PC | Physical Medicine & Rehabilitation | 2044 Madison Ave, Suite 15, Granite City, IL 62040-4641 | 2007-03-23 |
| 1710036025 | Irmady Bijoy Hegde | Physical Medicine & Rehabilitation | 2044 Madison Ave, Suite 15, Granite City, IL 62040-4641 | 2007-01-09 |
| 1134217169 | John R Williams Jr. | Surgery | 2044 Madison Ave, Suite 27, Granite City, IL 62040-4641 | 2006-10-11 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043736705 | Christine S Bieniecki Canada | Speech-Language Pathologist | 2300 West 25th St, Granite City, IL 62040 | 2017-08-15 |
| 1881085819 | James Watson | Counselor | 50 Northgate Industrial Drive, Granite City, IL 62040 | 2015-02-12 |
| 1518208719 | Chestnut Health Systems | Clinic/Center | 110 Northagte Industrial Drive, Granite City, IL 62040 | 2013-03-13 |
| 1952651697 | Victor Manuel Pinones | Dentist | 2130 Johnson Rd., Granite City, IL 62040 | 2012-09-10 |
| 1427360502 | Erin K Boerm | Occupational Therapist | 3540 Village Lane, Granite City, IL 62040 | 2010-07-06 |
| 1659503027 | Toni Lyn Siler | Counselor | 101 Whitsell Way, Apt 102, Pontoon Beach, IL 62040 | 2009-08-18 |
| 1871741462 | Fountain View Manor LLC | Alzheimer Center (Dementia Center) | 3432 Village Lane, Granite City, IL 62040 | 2008-09-08 |
| 1083880595 | Christina Marie Darin | Chiropractor | 2013 Johnson Road, Suite C & D, Granite City, IL 62040 | 2008-05-05 |
| 1629244322 | Julia Elaine Uhring Green | Counselor | 2429 Washinton Ave, Granite City, IL 62040 | 2008-05-02 |
| 1578786117 | John K Parker | Preventive Medicine | Veeder Health Center, 20th and Iowa, Granite City, IL 62040 | 2007-04-11 |
| Find all providers in zip 62040 | ||||
| Taxonomy Code | 208800000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Urology |
| A urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Urology, 2007. http://www.abu.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Urology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073503744 | Joseph J Ernst | Urology | 2100 Madison Ave, Suite 201, Granite City, IL 62040-4701 | 2005-10-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699236612 | Behdod Katebian | Urology | 5841 S Maryland Ave Rm J-653, Chicago, IL 60637-1443 | 2019-03-31 |
| 1912436015 | Robert Ara Petrossian | Urology | 301 N 8th St # 4b143c, Springfield, IL 62701-1041 | 2017-06-12 |
| 1134657026 | Soojin Kim | Urology | 225 E. Chicago Avenue, Box 24, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611 | 2017-05-23 |
| 1619337912 | George Robert Buckun | Urology | 930 Rogers St., #301, Downers Grove, IL 60515 | 2016-02-29 |
| 1275991606 | Nicole Alyssa Hamilton | Urology | 22285 N Pepper Rd Ste 201, Lake Barrington, IL 60010-2540 | 2016-01-30 |
| 1790164002 | Shay Golan | Urology | 5841 S Maryland Ave Mc6038, Chicago, IL 60637-1447 | 2015-05-20 |
| 1528453594 | Christopher Stockdale | Urology | 300 W Hill St Apt 707, Chicago, IL 60610-7537 | 2015-04-06 |
| 1639568447 | Jeremy Lai | Urology | 420 E Superior St Ste 9-900, Chicago, IL 60611-4494 | 2015-01-16 |
| 1386053759 | Ramiro Felix Prudencio | Urology | 1200 Broadmeadow Rd, Winnetka, IL 60093-3707 | 2014-08-10 |
| 1174933048 | Kyle John Ericson | Urology | 924 E 57th St, Suite 104, Chicago, IL 60637-1455 | 2014-05-01 |
| Find all providers with the same taxonomy | ||||
| City | GRANITE CITY |
| Zip Code | 62040 |
Please comment or provide details below to improve the information on FAIRVIEW HEIGHTS MEDICAL GROUP SC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.