FAIRVIEW HEIGHTS MEDICAL GROUP SC NPI 1538292370

NPI Information

  • NPI: 1538292370
  • Provider Name: FAIRVIEW HEIGHTS MEDICAL GROUP SC
  • Classification: Pediatrics - 2080P0202X
  • Specialization: Pediatric Cardiology
  • Entity Type: Organization
  • Doing Business As: PEDIACTRIC CARDIOLOGY OF ILLINOIS
  • Address: 2601 W MAIN ST
    CARBONDALE, IL
    ZIP 62901
  • Phone: (618) 549-5361

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NPI Details

FAIRVIEW HEIGHTS MEDICAL GROUP SC is a pediatric cardiology pediatrics in Carbondale, 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 1538292370. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Pediactric Cardiology Of Illinois.

The provider's business location address is:

2601 W MAIN ST
CARBONDALE, IL
ZIP 62901-031
Phone: (618) 549-5361

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: 3/30/2025

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