| Granite City Psychiatry Llc | |
|
2120 Madison Ave Suite 405 Granite City IL 62040-4744 | |
| (618) 876-0653 | |
| Not Available |
| Full Name | Granite City Psychiatry Llc |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 2120 Madison Ave, Granite City, Illinois |
| Authorized Official Name and Position | Karl Gundersen (MEMBER) |
| Authorized Official Contact | 6188760653 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Granite City Psychiatry Llc 2120 Madison Ave Suite 405 Granite City IL 62040-4744 Ph: () - | Granite City Psychiatry Llc 2120 Madison Ave Suite 405 Granite City IL 62040-4744 Ph: (618) 876-0653 |
| NPI Number | 1013269984 |
|---|---|
| Provider Enumeration Date | 10/02/2012 |
| Last Update Date | 10/02/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013269984 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | 036105102 (Illinois) | Primary |
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