FAIRVIEW HEIGHTS MEDICAL GROUP SC (NPI# 1417140609) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417140609 |
| Entity Type | Organization |
| Organization Name | FAIRVIEW HEIGHTS MEDICAL GROUP SC |
| Other Organization Name | ALTON UROLOGICAL ASSOCIATES EDWARDSVILLE |
| Practice Address |
8 Sunset Hills Professional Ctr Edwardsville IL 62025-3760 |
| Mailing Address |
670 Mason Ridge Center Dr Suite 300 Saint Louis MO 63141-8573 |
| Practice Telephone | 6186929828 |
| Practice Fax Number | 6186927337 |
| Mailing Telephone | 3149967644 |
| Mailing Fax Number | 3149967658 |
| Enumeration Date | 2007-08-22 |
| 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 Urological Associates Edwardsville | 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 |
| 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 |
| 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 |
8 SUNSET HILLS PROFESSIONAL CTR |
| City | EDWARDSVILLE |
| State | IL |
| Zip Code | 62025-3760 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841392651 | Janiece N Stewart | Internal Medicine | 8 Sunset Hills Professional Ctr, Edwardsville, IL 62025-3760 | 2006-09-02 |
| 1124387675 | Nishant Poddar | Internal Medicine | 8 Sunset Hills Professional Ctr, Ste 100, Edwardsville, IL 62025-3760 | 2012-05-03 |
| 1386787539 | Fairview Heights Medical Group Sc | Internal Medicine | 8 Sunset Hills Professional Ctr, Edwardsville, IL 62025-3760 | 2007-02-15 |
| 1255490280 | Michelle Kathryn Preston | Dietitian, Registered | 8 Sunset Hills Professional Ctr, Edwardsville, IL 62025-3760 | 2006-12-06 |
| 1023100195 | Christian Hospital Illinois Services | Clinic/Center | 8 Sunset Hills Professional Ctr, Edwardsville, IL 62025-3760 | 2006-09-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619519535 | Anderson Surgery Center LLC | Clinic/Center | 3403 Anderson Healthcare Drive, Edwardsville, IL 62025 | 2019-10-11 |
| 1194376640 | Katharine Mcginnis D.m.d. P.C. | Dentist | 235 A. South Main St, Edwardsville, IL 62025 | 2019-09-26 |
| 1568925014 | Southern Illinois Pediatric Dentistry of Edwardsville | Dentist | 1419 Lewis Road, Suite 2, Edwardsville, IL 62025 | 2019-04-11 |
| 1902277031 | Amy Lynn Britt | Nurse Practitioner | 1188 South State Route 157, Edwardsville, IL 62025 | 2015-10-15 |
| 1730563230 | Jenna Dallman | Chiropractor | 3 Sunset Hills Professional Center, Suite 2, Edwardsville, IL 62025 | 2015-07-14 |
| 1861745218 | Srimannarayana Marella | Family Medicine | 6616 Center Grove Rd., Edwardsville, IL 62025 | 2012-10-23 |
| 1669722872 | Ican Clinic LLC | Chiropractor | 441 S State Route 157 Ste 2, Edwardsville, IL 62025 | 2012-09-14 |
| 1922371673 | Teresa Marie Garbett | Pharmacist | 2 Sunset Hills Executive Park Dr., Addiction Treatment Strategies, Edwardsville, IL 62025 | 2012-02-10 |
| 1831324342 | Krista Nicole Nelson | Podiatrist | 235 S Main St Ste B, Edwardsville, IL 62025 | 2009-05-28 |
| 1447415757 | Harvey H Breckner D.m.d.,m.s | Exclusive Provider Organization | 600 Country Club View Suite 4, Edwardsville, IL 62025 | 2008-07-25 |
| Find all providers in zip 62025 | ||||
| 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 | EDWARDSVILLE |
| Zip Code | 62025 |
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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.