Granite City Psychiatry LLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

License

036105102 Issued in IL

Legal business name

GRANITE CITY PSYCHIATRY LLC

Practice address

2120 Madison Ave
Suite 405
Granite City, IL 62040-4744

Phone

(618) 876-0653

NPI assigned

Oct 2, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Karl Gundersen, MDNPI 1548362775

Title

Member

Phone

(618) 876-0653

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Karl Raymond Gundersen, MD

  • Psychiatry Physician
  • Granite City, IL
  • NPI 1548362775
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1349136000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1349136000000",
    "number": "1013269984",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2120 MADISON AVE",
            "address_2": "SUITE 405",
            "city": "GRANITE CITY",
            "state": "IL",
            "postal_code": "620404744"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2120 MADISON AVE",
            "address_2": "SUITE 405",
            "city": "GRANITE CITY",
            "state": "IL",
            "postal_code": "620404744",
            "telephone_number": "618-876-0653"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRANITE CITY PSYCHIATRY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-02",
        "last_updated": "2012-10-02",
        "status": "A",
        "authorized_official_last_name": "GUNDERSEN",
        "authorized_official_first_name": "KARL",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "618-876-0653",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "IL",
            "license": "036105102",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Granite City Illinois Hospital Company LLC
• Granite City Orthopedic Physicians Company LLC
• Granite City Physical Therapy LLC
• Granite City Physicians Corp
• Granite City Physicians Corp
• Granite City Urgent Care Walk-in Clinic
• Granite City Vision Ctr Inc
• Granite City Vision, Inc.
• Granite Nursing and Rehabilitation Center, LLC
• Great River Radiology, Inc

• Mental Health Clinic/Center (Including Community Mental Health Center) in Granite City, IL
• Providers in Granite City, IL by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.