Healthcare Provider Details

I. General information

NPI: 1558783647
Provider Name (Legal Business Name): ALTON MEMORIAL PHYSICIAN BILLING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2014
Last Update Date: 03/25/2021
Certification Date: 03/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PROFESSIONAL DR
ALTON IL
62002
US

IV. Provider business mailing address

1 MEMORIAL DRIVE ATTN: ADMINISTRATION
ALTON IL
62002-6722
US

V. Phone/Fax

Practice location:
  • Phone: 618-474-0130
  • Fax:
Mailing address:
  • Phone: 618-463-7268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SUSAN KOESTERER
Title or Position: VICE PRESIDENT, CFO
Credential:
Phone: 314-653-5715