Organization
OB PRACTICE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES B DAVIS (EXECUTIVE DIRECTOR)
(618) 257-4644
Entity
Organization
Contact information
Practice address
1404 CROSS ST, THIRD FLOOR SUITE 3181, SHILOH, IL 62269-2988
(618) 257-4644
Mailing address
4500 MEMORIAL DRIVE, MEMORIAL HOSPITAL MEDICAL AFFAIRS CREDENTIALING DEPT, BELLEVILLE, IL 62226
(618) 257-4644
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
—
—
207VG0400X
Gynecology Physician
—
—
207VX0000X
Obstetrics Physician
—
—
Other
Enumeration date
04/01/2016
Last updated
04/28/2016
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