Healthcare Provider Details

I. General information

NPI: 1952778474
Provider Name (Legal Business Name): ALTON MULTISPECIALISTS, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2015
Last Update Date: 09/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PROFESSIONAL DR
ALTON IL
62002-5068
US

IV. Provider business mailing address

1 PROFESSIONAL DR
ALTON IL
62002-5068
US

V. Phone/Fax

Practice location:
  • Phone: 618-463-8500
  • Fax: 618-474-0130
Mailing address:
  • Phone: 618-463-8500
  • Fax: 618-474-0130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0206X
TaxonomyMammography Clinic/Center
License Number
License Number StateIL

VIII. Authorized Official

Name: MRS. SHERRI R HENSON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 618-463-8534