MARYVILLE MEDICAL SERVICES, LLC (NPI# 1780614669) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1780614669 |
| Entity Type | Organization |
| Organization Name | MARYVILLE MEDICAL SERVICES, LLC |
| Practice Address |
6810 State Route 162 Suite 215 Maryville IL 62062-8501 |
| Practice Telephone | 6182885711 |
| Practice Fax Number | 6182884088 |
| Mailing Telephone | 6182885711 |
| Mailing Fax Number | 6182884088 |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2008-06-23 |
| Authorized Official Name | KEITH PAGE (CEO) |
| Authorized Official Telephone | 6182885711 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 103T00000X | Psychologist | Behavioral Health & Social Service Providers | ||
| Y | 367500000X | Nurse Anesthetist, Certified Registered | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487047627 | Maryville Medical Services, LLC | Emergency Medicine | 2504 Commerce, Highland, IL 62249-0017 | 2015-03-12 |
| 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 |
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| 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 | 367500000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Anesthetist, Certified Registered |
| (1) A licensed registered nurse with advanced specialty education in anesthesia who, in collaboration with appropriate health care professionals, provides preoperative, intraoperative, and postoperative care to patients and assists in management and resuscitation of critical patients in intensive care, coronary care, and emergency situations. Nurse anesthetists are certified following successful completion of credentials and state licensure review and a national examination directed by the Council on Certification of Nurse Anesthetists. (2) A registered nurse who is qualified by special training to administer anesthesia in collaboration with a physician or dentist and who can assist in the care of patients who are in critical condition. |
| Notes: Sources: (1) Council on Certification of Nurse Anesthetists, Park Ridge, IL, and Rhea, Ott, and Shafritz, The Facts On File Dictionary of Health Care Management, New York: Facts On File Publications, 1988. (2) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 548. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043750540 | Gina Saal | Nurse Anesthetist, Certified Registered | 6800 Rt 162, Maryville, IL 62062 | 2017-03-02 |
| 1952709446 | David Kinlaw | Nurse Anesthetist, Certified Registered | 2903 W Woodbine Dr, Maryville, TN 37803-0591 | 2014-12-15 |
| 1023055696 | Novamed Eye Surgery Center of Maryville, LLC | Nurse Anesthetist, Certified Registered | 12 Maryville Professional Park, Maryville, IL 62062 | 2006-06-01 |
| 1598373052 | Brittany Smith | Nurse Anesthetist, Certified Registered | 6800 State Route 162, Maryville, IL 62062-8500 | 2020-07-21 |
| 1285251033 | Cory Ray Austin | Nurse Anesthetist, Certified Registered | 6800 State Route 162, Maryville, IL 62062-8500 | 2020-06-28 |
| 1194210393 | Jared T Holton | Nurse Anesthetist, Certified Registered | 6800 State Route 162, Maryville, IL 62062-8500 | 2018-06-29 |
| 1396235933 | Amy Catherine Schollenberger | Nurse Anesthetist, Certified Registered | 6800 State Route 162, Maryville, IL 62062-8500 | 2018-05-17 |
| 1760905855 | Coleen Michele Spotts | Nurse Anesthetist, Certified Registered | 907 E Lamar Alexander Pkwy, Maryville, TN 37804-5015 | 2017-07-20 |
| 1841713955 | Tiffany Michelle Foster | Nurse Anesthetist, Certified Registered | 907 E Lamar Alexander Pkwy, Maryville, TN 37804-5015 | 2017-07-20 |
| 1124541248 | Donna Marie Mcmahan | Nurse Anesthetist, Certified Registered | 907 E Lamar Alexander Pkwy, Maryville, TN 37804-5015 | 2017-07-20 |
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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.