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General NPI Number Information
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NPI Number | 1861587586
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Entity Type | Organization
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Legal Business Name | XRT III, INC
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 02/26/2008
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Provider Practice Location Address
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Address Line | 326 FOUNTAINS PKWY
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City | FAIRVIEW HEIGHTS
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State | IL
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Zip | 62208-2041
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Country | US
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Telephone | 618-632-5501
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Fax | 618-632-5521
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Provider Business Mailing Address
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Address Line | 326 FOUNTAINS PKWY
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City | FAIRVIEW HEIGHTS
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State | IL
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Zip | 62208-2041
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Country | US
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Telephone | 618-632-5501
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Fax | 618-632-5521
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Authorized Official
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Title or Position | CO-OWNER
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Name | DR. MARY W CONTI
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Credential | M D
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Telephone | 618-632-5501
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State | IL
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