FAIRVIEW HEIGHTS MEDICAL GROUP SC (NPI# 1326171158) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1326171158 |
| Entity Type | Organization |
| Organization Name | FAIRVIEW HEIGHTS MEDICAL GROUP SC |
| Other Organization Name | PEDIATRIC CARDIOLOGY OF ILLINOIS |
| Practice Address |
4230 Lincolnshire Dr Ste A Mount Vernon IL 62864-2189 |
| Mailing Address |
670 Mason Ridge Center Dr Suite 300 Saint Louis MO 63141-8573 |
| Practice Telephone | 6182411833 |
| Mailing Telephone | 3149967644 |
| Mailing Fax Number | 3149967658 |
| Enumeration Date | 2007-03-13 |
| 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 | 2080P0202X |
Pediatrics Specialization: Pediatric Cardiology |
Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Pediatric Cardiology of Illinois | 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 |
| 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 |
4230 LINCOLNSHIRE DR STE A |
| City | MOUNT VERNON |
| State | IL |
| Zip Code | 62864-2189 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861021883 | Angela Jane Arcuri | Nurse Practitioner | 4230 Lincolnshire Dr Ste A, Mount Vernon, IL 62864-2189 | 2020-04-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619438892 | Melissa Pryer | Dietitian, Registered | 2020 Broadway, Suite 1, Mt. Vernon, IL 62864 | 2019-03-28 |
| 1487145454 | Chiropractic Wellness Center of Mt Vernon, LLC. | Chiropractor | 1009 S 42nd St Ste 5, Mount Vernon, IL 62864 | 2018-05-24 |
| 1851889208 | Kimberly Tate | Counselor | 4110 North Water Place, Mt. Vernon, IL 62864 | 2018-05-01 |
| 1871907790 | University Hematology Oncology Inc | Specialist | #11 Cusumano Professional Plaza, Mount Vernon, IL 62864 | 2014-06-18 |
| 1457771677 | Dynamic Counseling and Consultation Services | Social Worker | 3600 S Water Tower Pl, Mt Vernon, IL 62864 | 2014-04-27 |
| 1619239431 | Judith C Morgan | Counselor | 16338 N Illinois Hwy 37, Mount Vernon, IL 62864 | 2012-06-08 |
| 1073888624 | James Brian Verges | Counselor | 16338 N. Illinois Hwy 37, Mount Vernon, IL 62864 | 2012-03-15 |
| 1720352271 | Lucinda M. Holdren | Counselor | 16338 North Illinois Highway 37, Mount Vernon, IL 62864 | 2012-03-01 |
| 1780978627 | Jamie M Orange | Physical Therapy Assistant | 19958 Fairfield Rd, Mt. Vernon, IL 62864 | 2011-06-08 |
| 1780978791 | Wendy Marie Claytor | Speech-Language Pathologist | 600 E Il Hwy 15, Mount Vernon, IL 62864 | 2011-06-07 |
| Find all providers in zip 62864 | ||||
| Taxonomy Code | 2080P0202X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Pediatric Cardiology |
| A pediatric cardiologist provides comprehensive care to patients with cardiovascular problems. This specialist is skilled in selecting, performing and evaluating the structural and functional assessment of the heart and blood vessels, and the clinical evaluation of cardiovascular disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) was provided by the American Osteopathic Board of Pediatrics. The Certification is no longer offered. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386187458 | A2z Care Med-peds Specialists, PC | Pediatrics | 550 East Bougton Road, Suite 110, Bolingbrook, IL 60440-2194 | 2016-11-22 |
| 1003369836 | Peter Varga Md Sc | Pediatrics | 317 N Euclid Ave, Oak Park, IL 60302-2109 | 2016-07-28 |
| 1699153791 | Siddharth Dubey | Pediatrics | 400 N 9th St Fl 2, Springfield, IL 62702-5310 | 2015-05-11 |
| 1558759738 | Axiom Clinic, Sc | Pediatrics | 4202 Forest Ave, Downers Grove, IL 60515-2049 | 2014-12-22 |
| 1265853170 | Leo Henikoff Jr. | Pediatrics | 1437 W Lexington St, Chicago, IL 60607-4013 | 2013-12-18 |
| 1932425188 | Amy Marie O'connor | Pediatrics | 225 E Chicago Ave # 21, Chicago, IL 60611-2991 | 2010-04-13 |
| 1376709519 | Sanmit Kumar Basu | Pediatrics | 5841 S Maryland Ave # Mc4051, Chicago, IL 60637-1443 | 2008-08-06 |
| 1104012053 | Mukesh M. Doshi, M.d., S.c. | Pediatrics | 1768 Moon Lake Blvd, Suite 206, Hoffman Estates, IL 60169 | 2007-09-24 |
| 1740483627 | Priti M. Patel | Pediatrics | 530 Ne Glenoak Ave, Peoria, IL 61603-3133 | 2007-06-07 |
| 1134241383 | Ep Consultation, Ltd | Pediatrics | 910 W Van Buren St, Ste 226, Chicago, IL 60607-3523 | 2007-04-06 |
| Find all providers with the same taxonomy | ||||
| City | MOUNT VERNON |
| Zip Code | 62864 |
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.