FAIRVIEW HEIGHTS MEDICAL GROUP SC (NPI# 1538341094) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1538341094 |
| Entity Type | Organization |
| Organization Name | FAIRVIEW HEIGHTS MEDICAL GROUP SC |
| Other Organization Name | ALTON UROLOGY - GLEN CARBON |
| Practice Address |
2246 S State Route 157 Ste. 200 Glen Carbon IL 62034-1717 |
| Mailing Address |
670 Mason Ridge Center Dr Suite 300 Saint Louis MO 63141-8573 |
| Practice Telephone | 6182885888 |
| Practice Fax Number | 6182886475 |
| Mailing Telephone | 3149967644 |
| Mailing Fax Number | 3149967658 |
| Enumeration Date | 2007-11-27 |
| 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 Urology - Glen Carbon | 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 |
| 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 |
| 1487847638 | Fairview Heights Medical Group Sc | Urology | 2044 Madison Ave, Suite 15, Granite City, IL 62040-4641 | 2007-08-21 |
| 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 |
2246 S STATE ROUTE 157 STE. 200 |
| City | GLEN CARBON |
| State | IL |
| Zip Code | 62034-1717 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457887168 | Shawnee Hills Oral & Maxillofacial Surgery | Dentist | 2246 S State Route 157, Suite 325, Glen Carbon, IL 62034-1717 | 2017-05-02 |
| 1801042718 | Rodney L Bailey, Dmd, PC | Dentist | 2246 S State Route 157, Suite 125, Glen Carbon, IL 62034-1717 | 2008-08-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740787795 | Kaleena Galletta | Nurse Practitioner | 4273 S., Il - 159, Glen Carbon, IL 62034 | 2018-04-06 |
| 1871092502 | Andrea Lee Sullivan | Dentist | 3024 South Il-159, Glen Carbon, IL 62034 | 2018-02-08 |
| 1417464918 | Stages Health & Wellness, LLC | Nurse Practitioner | 14 Crabapple Lane, Glen Carbon, IL 62034 | 2018-01-05 |
| 1700300498 | Michael Jay Arnold | Dentist | 3024 Il-159, Glen Carbon, IL 62034 | 2017-08-03 |
| 1679024228 | 360 Body Wellness Inc | Internal Medicine | 3407 Il State Route 157, Glen Carbon, IL 62034 | 2016-10-19 |
| 1346621505 | Stephanie N Lorts | Pediatrics | 4804 South State Route 159, Glen Carbon, IL 62034 | 2015-06-13 |
| 1205110111 | James Allan Staley | Pharmacist | #2 Cottonwood Rd, Glen Carbon, IL 62034 | 2011-10-11 |
| 1215224357 | Angela Eleni Kioultzopoulos | Speech-Language Pathologist | 7a Ginger Creek Village Dr., Glen Carbon, IL 62034 | 2011-07-08 |
| 1922320795 | Meridian Village Association | Skilled Nursing Facility | 27 Auerbach Place, Glen Carbon, IL 62034 | 2010-02-22 |
| 1679728356 | Erin Kathleen Immken | Counselor | 98 Junction Drive West, Suite 6, Glen Carbon, IL 62034 | 2008-11-24 |
| Find all providers in zip 62034 | ||||
| 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 |
|---|---|---|---|---|
| 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 | GLEN CARBON |
| Zip Code | 62034 |
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.