Basic Information
| Provider Information | |||||||||
| NPI: | 1619246485 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OA ASSOCIATES LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4700 MEMORIAL DR | ||||||||
| Address2: | STE. 340 | ||||||||
| City: | BELLEVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622265370 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6182349884 | ||||||||
| FaxNumber: | 6182359020 | ||||||||
| Practice Location | |||||||||
| Address1: | 4700 MEMORIAL DR | ||||||||
| Address2: | STE. 340 | ||||||||
| City: | BELLEVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622265370 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6182349884 | ||||||||
| FaxNumber: | 6182359020 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/22/2011 | ||||||||
| LastUpdateDate: | 12/22/2011 | ||||||||
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| AuthorizedOfficialLastName: | DAVIS | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 6182576301 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | OA ASSOCIATES LLC | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.