Provider Demographics
NPI:1154798882
Name:ALTON MULTISPECIALISTS, LTD.
Entity type:Organization
Organization Name:ALTON MULTISPECIALISTS, LTD.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERRI
Authorized Official - Middle Name:R
Authorized Official - Last Name:HENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-463-8534
Mailing Address - Street 1:1 PROFESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-5068
Mailing Address - Country:US
Mailing Address - Phone:618-463-8500
Mailing Address - Fax:618-474-0130
Practice Address - Street 1:1 PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-5068
Practice Address - Country:US
Practice Address - Phone:618-463-8500
Practice Address - Fax:618-474-0130
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALTON MULTISPECIALISTS, LTD.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-08-28
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL100867OtherMAMMOGRAPHY SERVICES