Provider Demographics
NPI:1316251788
Name:MSA ALLIANCE
Entity type:Organization
Organization Name:MSA ALLIANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP MEDICAL STAFF SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:B
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:FACHE, MBA, MHSA
Authorized Official - Phone:618-257-6302
Mailing Address - Street 1:PO BOX 24035
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62223-9035
Mailing Address - Country:US
Mailing Address - Phone:618-222-9999
Mailing Address - Fax:618-222-9337
Practice Address - Street 1:4600 MEMORIAL DR
Practice Address - Street 2:STE 325
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62226-5368
Practice Address - Country:US
Practice Address - Phone:618-236-6501
Practice Address - Fax:618-236-6551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-28
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty