Provider Demographics
NPI:1750368809
Name:ALTON CENTER OF BONE AND JOINT SURGERY
Entity type:Organization
Organization Name:ALTON CENTER OF BONE AND JOINT SURGERY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:SEGRIST
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:618-462-1722
Mailing Address - Street 1:533 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-6302
Mailing Address - Country:US
Mailing Address - Phone:618-462-1722
Mailing Address - Fax:618-462-1741
Practice Address - Street 1:533 E 3RD ST
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-6302
Practice Address - Country:US
Practice Address - Phone:618-462-1722
Practice Address - Fax:618-462-1741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL208008Medicare ID - Type Unspecified