DataLabs
datalabs.health made in the usa
DataLabs Facebook Wall   Like   Follow DataLabs on Twitter   Tweet  
Contact us Sign in |  Documentation | 
NPI Code Detail

MEDICARE: GRANITE CITY CLINIC CORP

MEDICARE: GRANITE CITY CLINIC CORP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207L00000XAnesthesiology Physician
2367500000XCertified Registered Nurse Anesthetist

General Provider Information

NPI Number : 1003892464
Entity Type Code : Organization
Provider Name (Legal Business Name) : GRANITE CITY CLINIC CORP
Provider Business Mailing Address
First Line : P O BOX 503734
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63150-0001
Country : US
Telephone Number : 660-826-5960
Fax Number : 660-826-4852
Provider Business Practice Location Address
First Line : 2100 MADISON AVE
Second Line :
City : GRANITE CITY
State : IL
Zip : 62040-4701
Country : US
Telephone Number : 618-798-3000
Fax Number :
Authorized Official
Title or Position : VP
Name : GARY NEWSOME
Credential :
Telephone Number : 615-465-7000
Provider Enumeration Date : 12/19/2005
Last Update Date : 07/30/2007

Similar Medicare Providers

1265439640 — TIMOTHY HIPSKIND
Practice Location Address:
2100 MADISON AVE
GRANITE CITY, IL
62040-4701
Practice Phone: 618-798-3000
Practice Fax: 618-798-3000
1285629212 — DR. JOWE HSIEH MD
Practice Location Address:
2100 MADISON AVE
GRANITE CITY, IL
62040-4701
Practice Phone: 618-452-3301
Practice Fax: 618-452-3312
1902881733 — RICK CORBETT CRNA
Practice Location Address:
2100 MADISON AVE
GRANITE CITY, IL
62040-4701
Practice Phone: 618-343-0048
Practice Fax: 618-343-0048
1598740284 — MARY BIGONGIARI CRNA
Practice Location Address:
2100 MADISON AVE
GRANITE CITY, IL
62040-4701
Practice Phone: 660-826-5960
Practice Fax: 660-826-4852
1932185469 — TIMOTHY O'CONNOR CRNA
Practice Location Address:
2100 MADISON AVE
GRANITE CITY, IL
62040-4701
Practice Phone: 660-826-5960
Practice Fax: 660-826-4852
1083685986 — GRANITE CITY ILLINOIS HOSPITAL COMPANY LLC
Practice Location Address:
2100 MADISON AVE
GRANITE CITY, IL
62040-4701
Practice Phone: 618-798-3000
Practice Fax: 618-798-3724

Directions to “GRANITE CITY CLINIC CORP ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.