Healthcare Provider Details

I. General information

NPI: 1285741165
Provider Name (Legal Business Name): CHILDRENS MEDICAL ASSOCIATES,LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4550 MEMORIAL DR STE 260
BELLEVILLE IL
62226-5359
US

IV. Provider business mailing address

4550 MEMORIAL DR STE 260
BELLEVILLE IL
62226-5359
US

V. Phone/Fax

Practice location:
  • Phone: 618-236-6336
  • Fax: 618-236-9582
Mailing address:
  • Phone: 618-236-6336
  • Fax: 618-236-9582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT LOUIS QUAAS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 618-236-6336