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FAIRVIEW HEIGHTS MEDICAL GROUP SC NPI 1326171158


NPI Information

NPI: 1326171158
Provider Name: FAIRVIEW HEIGHTS MEDICAL GROUP SC

Doing Business As: PEDIATRIC CARDIOLOGY OF ILLINOIS

Classification: Pediatrics - 2080P0202X
Entity Type: Organization

Specialization: Pediatric Cardiology

Address:
4230 LINCOLNSHIRE DR STE A
MOUNT VERNON, IL
ZIP 62864
Phone: (618) 241-1833
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FAIRVIEW HEIGHTS MEDICAL GROUP SC is a pediatric cardiology pediatrics in Mount Vernon, IL. The provider is 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. FAIRVIEW HEIGHTS MEDICAL GROUP SC NPI is 1326171158. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Pediatric Cardiology Of Illinois.

The provider's business location address is:

4230 LINCOLNSHIRE DR STE A
MOUNT VERNON, IL
ZIP 62864-189
Phone: (618) 241-1833

The provider's authorized official is Raymond P Davidson .
The authorized official title is President and has the following contact phone number (314) 286-2028.

The enumeration date for this NPI number is 3/13/2007 and was last updated on 1/7/2008.


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 Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
12080P0202XPediatricsPediatric CardiologyYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1413610MEDICARE ID-TYPE UNSPECIFIEDILLINOIS

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: 5/5/2024

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