MARYVILLE INTERNAL MEDICINE LTD NPI 1730230848

NPI Information

NPI: 1730230848
Provider Name: MARYVILLE INTERNAL MEDICINE, LTD
Classification: Clinic/Center - 261QP2300X
Entity Type: Organization

Specialization: Primary Care

Address:
6810 STATE ROUTE 162
SUITE 205
MARYVILLE, IL
ZIP 62062
Phone: (618) 288-2120
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MARYVILLE INTERNAL MEDICINE, LTD is a primary care clinic center in Maryville, IL. MARYVILLE INTERNAL MEDICINE, LTD NPI is 1730230848. The provider is registered as an organization entity type.

The provider's business location address is:

6810 STATE ROUTE 162
SUITE 205
MARYVILLE, IL
ZIP 62062-501
Phone: (618) 288-2120
Fax: (618) 288-2123

The provider's authorized official is Kevin B. Garner .
The authorized official title is President and has the following contact phone number (618) 288-2120.

The enumeration date for this NPI number is 1/15/2007 and was last updated on 8/22/2020.

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
1	261QP2300X	Clinic/Center	Primary Care		ILLINOIS	Yes

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

NPI Synchronization or Removal

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