MEDICARE: OA ASSOCIATES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207XX0004X	Orthopaedic Foot and Ankle Surgery Physician
2	207X00000X	Orthopaedic Surgery Physician

General Provider Information

NPI Number	:	1588189419
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OA ASSOCIATES LLC

Provider Business Mailing Address
First Line	:	4500 MEMORIAL DR
Second Line	:
City	:	BELLEVILLE
State	:	IL
Zip	:	62226-5360
Country	:	US
Telephone Number	:	618-257-4644
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 ADMIRAL TROST RD
Second Line	:
City	:	COLUMBIA
State	:	IL
Zip	:	62236-2163
Country	:	US
Telephone Number	:	618-281-7373
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	JAMES B DAVIS
Credential	:
Telephone Number	:	618-257-4644

Provider Enumeration Date	:	08/11/2017
Last Update Date	:	08/11/2017

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