NPIMap

Organization Active NPI

Granite City Physicians Corp

  • Clinical Medical Laboratory
  • Granite City, IL
National Provider Identifier
1508983214
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
Legal business name
GRANITE CITY PHYSICIANS CORP
Practice address
2044 Madison Ave
Suite 15
Granite City, IL 62040-4641
Phone
(618) 451-1500
NPI assigned
Mar 26, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Gary Newsome
Title
Vice President
Phone
(618) 451-1500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X Primary

Addresses

Primary practice location

2044 Madison Ave
Suite 15
Granite City, IL 62040-4641

Mailing address

2044 Madison Ave
Suite 15
Granite City, IL 62040-4641
Phone (618) 451-1500

National Provider Directory

National Provider Directory

Locations

101 United Dr
Collinsville, IL 62234
Phone (618) 344-0248

800 Saint Louis Rd
Collinsville, IL 62234
Phone (618) 344-0068

2044 Madison Ave
Ste 22
Granite City, IL 62040
Phone (618) 877-6800

2044 Madison Ave
Ste 23
Granite City, IL 62040
Phone (618) 451-1500

Practitioners & affiliated clinicians

Practitioners 125

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 125

NPI Registry JSON

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

{
    "created_epoch": "1174867200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1508983214",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2044 MADISON AVE",
            "address_2": "SUITE 15",
            "city": "GRANITE CITY",
            "state": "IL",
            "postal_code": "620404641",
            "telephone_number": "618-451-1500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2044 MADISON AVE",
            "address_2": "SUITE 15",
            "city": "GRANITE CITY",
            "state": "IL",
            "postal_code": "620404641",
            "telephone_number": "618-451-1500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRANITE CITY PHYSICIANS CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-26",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "NEWSOME",
        "authorized_official_first_name": "GARY",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "618-451-1500"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Granite City, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.