NPI 1003892464

Granite City Clinic Corp

Organisation Certified Registered Nurse Anesthetist Granite City, IL

Practice location

Address: 2100 Madison Ave, Granite City, IL 62040-4701
Phone: (618) 798-3000
Mailing address: P O Box 503734, Saint Louis, MO 63150-0001

Authorised official

Name: Gary Newsome
Title: Vp
Phone: (615) 465-7000

Registered specialties (2)

Certified Registered Nurse Anesthetist Primary

Physician Assistants & Advanced Practice Nursing Providers Taxonomy 367500000X

Other Nurse Anesthetist, Certified Registered providers in Illinois →

Anesthesiology Physician

Allopathic & Osteopathic Physicians Taxonomy 207L00000X

Other Anesthesiology providers in Illinois →

Registry record

NPI: 1003892464
Entity type: Organization
NPI issued: 19 Dec 2005
Record last updated: 30 Jul 2007

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.