NPIMap

Organization Active NPI

Msa Alliance, LLC

  • Vascular Surgery Physician
  • Belleville, IL
National Provider Identifier
1063728038
Registry record updated Feb 22, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
Legal business name
MSA ALLIANCE, LLC
Practice address
4600 Memorial Dr
Ste 240
Belleville, IL 62226-5368
Phone
(618) 222-1020
Fax
(618) 222-1039
NPI assigned
Aug 27, 2010
Organization subpart
Yes
Parent organization
MSA ALLIANCE, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 22, 2013

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

Authorized official

Name
James B. Davis
Title
Executive Director
Phone
(618) 257-4644

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular Surgery PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2086S0129X Primary

Addresses

Primary practice location

4600 Memorial Dr
Ste 240
Belleville, IL 62226-5368

Mailing address

4500 Memorial Dr
Medical Affairs Credentialing Department
Belleville, IL 62226-5360
Phone (618) 257-4644

National Provider Directory

National Provider Directory
Tax ID family
Msa Alliance LLC45 organizations share this tax ID, including this one
Part of
Msa Alliance LLC

Other organizations with this tax ID 44

Organizations that report the same tax identification number in the National Provider Directory.

View all 44

NPI Registry JSON

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

{
    "created_epoch": "1282867200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1361491200000",
    "number": "1063728038",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4500 MEMORIAL DR",
            "address_2": "MEDICAL AFFAIRS CREDENTIALING DEPARTMENT",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622265360",
            "telephone_number": "618-257-4644",
            "fax_number": "618-257-6946"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4600 MEMORIAL DR",
            "address_2": "STE 240",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622265368",
            "telephone_number": "618-222-1020",
            "fax_number": "618-222-1039"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MSA ALLIANCE, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MSA ALLIANCE, LLC",
        "enumeration_date": "2010-08-27",
        "last_updated": "2013-02-22",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "B.",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "618-257-4644"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Surgery, Vascular Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Belleville, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2013; 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.