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General NPI Number Information
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NPI Number | 1942312442
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Entity Type | Organization
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Legal Business Name | ALTON MULTISPECIALISTS, LTD.
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 08/30/2016
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Provider Practice Location Address
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Address Line | 1 PROFESSIONAL DR
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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 | 618-463-8500
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Fax | 618-474-0130
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Provider Business Mailing Address
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Address Line | 1 PROFESSIONAL DR
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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 | 618-463-8500
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Fax | 618-474-0130
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. SHERRI R HENSON
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Credential |
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Telephone | 618-463-8634
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 036-071248
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 261QR0206X
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Taxonomy Name | Mammography Clinic/Center
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License Number | 100867
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License Number State | IL
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