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Organization

OB PRACTICE, LLC

Active
Parent organization
OB PRACTICE, LLC
Organization subpart
Yes

Provider details

NPI number
Legal business name
OB PRACTICE, LLC
Authorized official
JAMES B. DAVIS (EXECUTIVE DIRECTOR)
(618) 257-4644
Entity
Organization

Contact information

Practice address
4600 MEMORIAL DRIVE, STE. 400, BELLEVILLE, IL 62226
(618) 234-2390
(618) 234-9936
Mailing address
4500 MEMORIAL DR, MEDICAL AFFAIRS CREDENTIALING DEPARTMENT, BELLEVILLE, IL 62226-5360
(618) 257-4644
(618) 257-6946

Taxonomy

Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
207VG0400X
Gynecology Physician

Other

Enumeration date
09/14/2010
Last updated
07/21/2022
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