Provider Demographics
NPI:1912098807
Name:SCHRANCK, CHARLES R JR (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:R
Last Name:SCHRANCK
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:55 WESTPORT PLAZA DRIVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146
Mailing Address - Country:US
Mailing Address - Phone:314-548-4772
Mailing Address - Fax:314-548-4748
Practice Address - Street 1:ONE MEMORIAL DRIVE
Practice Address - Street 2:ALTON MEMORIAL HOSPITAL
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002
Practice Address - Country:US
Practice Address - Phone:618-463-7415
Practice Address - Fax:314-821-2180
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2010-04-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL0360801492085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208893305Medicaid
MO208893305Medicaid
ILL40191Medicare PIN