Provider Demographics
NPI:1053713750
Name:OA ASSOCIATES LLC DBA ORTHOPEDIC AND SPORTS MEDICINE LTD.
Entity type:Organization
Organization Name:OA ASSOCIATES LLC DBA ORTHOPEDIC AND SPORTS MEDICINE LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:B
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-257-4644
Mailing Address - Street 1:4700 MEMORIAL DR
Mailing Address - Street 2:SUITE 340
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62226-5373
Mailing Address - Country:US
Mailing Address - Phone:618-234-9884
Mailing Address - Fax:618-235-9020
Practice Address - Street 1:4500 MEMORIAL DRIVE
Practice Address - Street 2:MEMORIAL HOSPITAL MEDICAL AFFAIRS
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62226
Practice Address - Country:US
Practice Address - Phone:618-257-4644
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-24
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty