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Contact Information

MEMORIAL MEDICAL GROUP, LLC
4550 MEMORIAL DR
STE. 340
BELLEVILLE, IL62226-5372
 Phone: 618-257-6302
 Fax: 618-257-4838
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Internal Medicine

207R00000X 11 Physician/Internal Medicine
 

Cardiovascular Disease

207RC0000X 11 Physician/Internal Medicine
 

Clinical Cardiac Electrophysiology

207RC0001X 11 Physician/Internal Medicine
 

Family Medicine

207Q00000X 08 Physician/Family Practice
 

Gastroenterology

207RG0100X 10 Physician/Gastroenterology
 

Geriatric Medicine

207RG0300X 11 Physician/Internal Medicine
 

Obstetrics & Gynecology

207V00000X 16 Physician/Obstetrics & Gynecology
 

Orthopaedic Surgery

207X00000X 02 Physician/General Surgery
 

Pain Medicine

207LP2900X 05 Physician/Anesthesiology
 

Physical Medicine & Rehabilitation

208100000X 25 Physician/Physical Medicine and Rehabilitation
 

Plastic and Reconstructive Surgery

2086S0122X 02 Physician/General Surgery
 

Pulmonary Disease

207RP1001X 11 Physician/Internal Medicine
 

Sports Medicine

207RS0010X 11 Physician/Internal Medicine
 

Urology

208800000X 34 Physician/Urology
 

Vascular Surgery

2086S0129X 76 Physician/Peripheral Vascular Disease
Indicates primary specialty

NPI Profile & details for MEMORIAL MEDICAL GROUP, LLC

NPI Number 1235474057
LBN Legal business name MEMORIAL MEDICAL GROUP, LLC
Authorized official JAMES DAVIS - (EXECUTIVE DIRECTOR)
Entity Organization
Organization subpart 1 No
Enumeration date 12/05/2012
Last updated 12/05/2012 - About 14 years ago
Identifiers n/a
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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