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General NPI Number Information
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NPI Number | 1659589703
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Entity Type | Organization
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Legal Business Name | ALTON MULTISPECIALISTS
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Dates
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Enumeration Date | 05/21/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1 PROFESSIONAL DR SUITE 40
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City | ALTON
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State | IL
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Zip | 62002-5068
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Country | US
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Telephone | 618-463-8530
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Fax | 618-463-8536
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Provider Business Mailing Address
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Address Line | 1 PROFESSIONAL DR SUITE 40
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City | ALTON
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State | IL
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Zip | 62002-5068
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Country | US
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Telephone | 618-463-8530
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Fax | 618-463-8536
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Authorized Official
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Title or Position | PHYSICIAN SERVICES
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Name | MS. BRENDA S KASTEN
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Credential |
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Telephone | 618-463-8690
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2471M2300X
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Taxonomy Name | Mammography Radiologic Technologist
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License Number | 100867
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License Number State | IL
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