ANDERSON MEDICAL GROUP, LLC (NPI# 1700807716) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1700807716 |
| Entity Type | Organization |
| Organization Name | ANDERSON MEDICAL GROUP, LLC |
| Practice Address |
6810 State Route 162 Suite 215 Maryville IL 62062-8501 |
| Practice Telephone | 6182885711 |
| Practice Fax Number | 6182884088 |
| Mailing Telephone | 6182885711 |
| Enumeration Date | 2006-07-22 |
| Last Update Date | 2020-02-11 |
| Authorized Official Name | MICHAEL MARSHALL (CFO) |
| Authorized Official Telephone | 6183916402 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM1300X |
Clinic/Center Specialization: Multi-Specialty |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Anderson Medical Group | Doing Business As Name - Organization |
| Street Address |
6810 STATE ROUTE 162 SUITE 215 |
| City | MARYVILLE |
| State | IL |
| Zip Code | 62062-8501 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922009943 | Mark Stephen Fedder | Internal Medicine | 6810 State Route 162, Suite 211, Maryville, IL 62062-8501 | 2005-08-02 |
| 1003295213 | Msa Alliance, LLC Dba-southern Illinois Vascular and Vein Surgery | Surgery | 6810 State Route 162, Suite 100, Maryville, IL 62062 | 2015-05-20 |
| 1467867234 | Premier Foot and Ankle of Illinois, PC | Podiatrist | 6810 State Route 162, Suite 20, Maryville, IL 62062-8587 | 2014-06-30 |
| 1043521719 | Gabriel Cardenas Jr. | Podiatrist | 6810 State Route 162, Suite 20, Maryville, IL 62062-8587 | 2010-06-28 |
| 1780818831 | Patricia Renee Verdu | Registered Nurse | 6810 State Route 162, Maryville, IL 62062-8501 | 2009-05-04 |
| 1518143254 | James J. Dalla Riva, Md, PC | Specialist | 6810 State Route 162, Suite 301, Maryville, IL 62062-8501 | 2008-01-11 |
| 1184806101 | Mark Fedder, Md, PC | Internal Medicine | 6810 State Route 162, Suite 211, Maryville, IL 62062-8501 | 2007-11-30 |
| 1518178730 | Melissa Ann Kershaw | Internal Medicine | 6810 State Route 162, Ste 102, Maryville, IL 62062-8501 | 2007-05-28 |
| 1710009840 | James W. Lane | Psychologist | 6810 State Route 162, Suite 215, Maryville, IL 62062-8501 | 2007-04-06 |
| 1245373489 | Fairview Heights Medical Group Sc | Internal Medicine | 6810 State Route 162, Suite 203, Maryville, IL 62062-8501 | 2007-02-15 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104325091 | Jennifer M Oyler | Physician Assistant | 6812 State Route 162 Suite 120, Maryville, IL 62062 | 2018-02-06 |
| 1710495965 | Sarah Elizabeth Barto | Family Medicine | 2133 Vadalabene Drive, Suite Sb, Maryville, IL 62062 | 2018-01-22 |
| 1104348085 | Lindsey Nicole Langendorf | Chiropractor | 62 Executive Plaza Ct, Maryville, IL 62062 | 2017-07-12 |
| 1043750540 | Gina Saal | Nurse Anesthetist, Certified Registered | 6800 Rt 162, Maryville, IL 62062 | 2017-03-02 |
| 1548657737 | Karen Michelle Bertels | Emergency Medicine | 6800 Il - 162, Maryville, IL 62062 | 2015-04-25 |
| 1811258148 | Debra Ann Hoelscher | Internal Medicine | 2102 Vadalabene, Maryville, IL 62062 | 2012-06-04 |
| 1538438445 | Casey Elizabeth Wiesemeyer | Speech-Language Pathologist | 2201 Copper Creek Rd, Maryville, IL 62062 | 2011-12-21 |
| 1407144819 | Norah Claire Farley Baker | Family Medicine | 10 Professional Park Dr., Maryville, IL 62062 | 2011-07-19 |
| 1891092474 | Kimberly M Schneider | Physician Assistant | 20b Professional Park Drive, Maryville, IL 62062 | 2011-02-17 |
| 1669782397 | Purandhri Patel | Physical Therapist | 6820 State Route 162, Maryville, IL 62062 | 2010-10-15 |
| Find all providers in zip 62062 | ||||
| Taxonomy Code | 261QM1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Multi-Specialty |
| Definition to come... |
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| 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.