Basic Information
| Provider Information | |||||||||
| NPI: | 1760873616 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MSA ALLIANCE, LLC DBA PULMONARY PHYSICIANS OF SOUTHERN ILLINOIS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4500 MEMORIAL DRIVE | ||||||||
| Address2: | MEMORIAL HOSPITAL MEDICAL AFFAIRS | ||||||||
| City: | BELLEVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 62226 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6182574644 | ||||||||
| FaxNumber: | 6182576946 | ||||||||
| Practice Location | |||||||||
| Address1: | 1245 S MILL ST | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622632004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6183278119 | ||||||||
| FaxNumber: | 6183278141 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/13/2015 | ||||||||
| LastUpdateDate: | 02/17/2015 | ||||||||
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| AuthorizedOfficialLastName: | DAVIS | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | B. | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 6182574644 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0200X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207RS0012X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Sleep Medicine | 207RP1001X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
No ID Information.