Healthcare Provider Details

I. General information

NPI: 1437462637
Provider Name (Legal Business Name): PC ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2010
Last Update Date: 07/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 S MAIN ST
DUPO IL
62239-1325
US

IV. Provider business mailing address

PO BOX 23830
BELLEVILLE IL
62223-0830
US

V. Phone/Fax

Practice location:
  • Phone: 618-286-5251
  • Fax: 618-286-5677
Mailing address:
  • Phone: 618-222-9999
  • Fax: 618-222-9337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES B DAVIS
Title or Position: VP MEDICAL STAFF SERVICES
Credential: FACHE, MBA, MHSA
Phone: 618-257-6302