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Organization
PC ASSOCIATES LLC
Active
Organization
PC ASSOCIATES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAMES B. DAVIS FACHE, MBA, MHSA (EXECUTIVE DIRECTOR)
(618) 257-6301
Entity
Organization
Contact information
Practice address
310 NORTH SEVEN HILLS ROAD, O'FALLON, IL 62269
(618) 624-6181
(618) 622-2593
Mailing address
4500 MEMORIAL DRIVE, MEDICAL AFFAIRS OFFICE, BELLEVILLE, IL 62226
(618) 257-4644
(618) 257-6946
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
—
—
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
036053136
IL
Other
Enumeration date
03/10/2010
Last updated
07/29/2014
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