Organization
PROACTIVE MD IL SC
Active
Other names
OE 520 Health Center
Organization subpart
No
Provider details
NPI number
Authorized official
MARK KEMBLE MD (CMO)
(864) 501-0751
Entity
Organization
Contact information
Practice address
1472 N GREEN MOUNT RD, O FALLON, IL 62269-3416
(730) 240-8040
Mailing address
124 ALLAWOOD CT, SIMPSONVILLE, SC 29681-6207
(864) 501-0751
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Enumeration date
04/07/2025
Last updated
04/07/2025
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