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MEMORIAL MEDICAL GROUP LLC NPI 1235474057


NPI Information

NPI: 1235474057
Provider Name: MEMORIAL MEDICAL GROUP, LLC
Classification: Internal Medicine - 207R00000X
Entity Type: Organization
Address:
4550 MEMORIAL DR
STE. 340
BELLEVILLE, IL
ZIP 62226
Phone: (618) 257-6302
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MEMORIAL MEDICAL GROUP, LLC is an internal medicine in Belleville, IL. The provider is a physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. MEMORIAL MEDICAL GROUP, LLC NPI is 1235474057. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

4550 MEMORIAL DR
STE. 340
BELLEVILLE, IL
ZIP 62226-372
Phone: (618) 257-6302
Fax: (618) 257-4838

The provider's authorized official is James B. Davis .
The authorized official title is Executive Director and has the following contact phone number (618) 257-6302.

The enumeration date for this NPI number is 12/5/2012 and was last updated on 12/5/2012.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207LP2900XAnesthesiologyPain MedicineNo
2207Q00000XFamily MedicineNo
3207RC0000XInternal MedicineCardiovascular DiseaseNo
4207RC0001XInternal MedicineClinical Cardiac ElectrophysiologyNo
5207RG0100XInternal MedicineGastroenterologyNo
6207RG0300XInternal MedicineGeriatric MedicineNo
7207RP1001XInternal MedicinePulmonary DiseaseNo
8207RS0010XInternal MedicineSports MedicineNo
9207V00000XObstetrics & GynecologyNo
10207X00000XOrthopaedic SurgeryNo
11208100000XPhysical Medicine & RehabilitationNo
122086S0122XSurgeryPlastic and Reconstructive SurgeryNo
132086S0129XSurgeryVascular SurgeryNo
14208800000XUrologyNo
15207R00000XInternal MedicineYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

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