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General NPI Number Information
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NPI Number | 1295159184
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Entity Type | Organization
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Legal Business Name | CA GROUP, LLC
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Dates
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Enumeration Date | 02/12/2014
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Last Update Date | 02/12/2014
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Provider Practice Location Address
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Address Line | 4017 ILLINOIS ROUTE 159 SUITE 101
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City | SMITHTON
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State | IL
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Zip | 62285
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Country | US
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Telephone | 618-257-2875
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Fax | 618-257-2895
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Provider Business Mailing Address
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Address Line | 4017 ILLINOIS ROUTE 159 SUITE 101
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City | SMITHTON
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State | IL
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Zip | 62285
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Country | US
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Telephone | 618-257-2875
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Fax | 618-257-2895
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. JAMES B. DAVIS
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Credential |
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Telephone | 618-257-4644
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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