Provider Demographics
NPI:1659589703
Name:ALTON MULTISPECIALISTS
Entity Type:Organization
Organization Name:ALTON MULTISPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN SERVICES
Authorized Official - Prefix:MS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:S
Authorized Official - Last Name:KASTEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-463-8690
Mailing Address - Street 1:1 PROFESSIONAL DR
Mailing Address - Street 2:SUITE 40
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-5068
Mailing Address - Country:US
Mailing Address - Phone:618-463-8530
Mailing Address - Fax:618-463-8536
Practice Address - Street 1:1 PROFESSIONAL DR
Practice Address - Street 2:SUITE 40
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-5068
Practice Address - Country:US
Practice Address - Phone:618-463-8530
Practice Address - Fax:618-463-8536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1008672471M2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471M2300XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMammographyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL140212Medicare ID - Type UnspecifiedMAMMOGRAMS