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Organization
OA ASSOCIATED LLC
Active
Organization
OA ASSOCIATED LLC
Active
Other names
Southern Illinois Sports Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
JASON DANIEL NOELDNER ATC,LAT (ATHLETIC TRAINER)
(618) 236-2246
Entity
Organization
Contact information
Practice address
4550 MEMORIAL DR, MOC-1, SUITE G-100, BELLEVILLE, IL 62226-5372
(618) 236-2246
(618) 236-2315
Mailing address
4550 MEMORIAL DR, MOC-1, SUITE G-100, BELLEVILLE, IL 62226-5372
(618) 236-2246
(618) 236-2315
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
096002594
IL
Other
Enumeration date
06/22/2011
Last updated
06/22/2011
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