NPIMap

Organization Active NPI

PC Associates LLC

  • Family Medicine Physician
  • Okawville, IL
National Provider Identifier
1194086157
Registry record updated Feb 21, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036052179 Issued in IL
Legal business name
PC ASSOCIATES LLC
Practice address
205 East Belleville Street
Okawville, IL 62271
Phone
(618) 327-8119
Fax
(618) 327-8141
NPI assigned
Jun 6, 2012
Organization subpart
Yes
Parent organization
PC ASSOCIATES LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 21, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
James B. Davis
Title
Executive Director
Phone
(618) 257-4644

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207Q00000X 036052179 IL Primary

Addresses

Primary practice location

205 East Belleville Street
Okawville, IL 62271

Mailing address

4500 Memorial Dr
Medical Affairs Credentialing Office
Belleville, IL 62226-5360
Phone (618) 257-4644

National Provider Directory

National Provider Directory
Tax ID family
PC Associates LLC25 organizations share this tax ID, including this one
Part of
PC Associates LLC

Other organizations with this tax ID 24

Organizations that report the same tax identification number in the National Provider Directory.

View all 24

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1338940800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1361404800000",
    "number": "1194086157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4500 MEMORIAL DR",
            "address_2": "MEDICAL AFFAIRS CREDENTIALING OFFICE",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622265360",
            "telephone_number": "618-257-4644",
            "fax_number": "618-257-6946"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 EAST BELLEVILLE STREET",
            "city": "OKAWVILLE",
            "state": "IL",
            "postal_code": "62271",
            "telephone_number": "618-327-8119",
            "fax_number": "618-327-8141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PC ASSOCIATES LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PC ASSOCIATES LLC",
        "enumeration_date": "2012-06-06",
        "last_updated": "2013-02-21",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "B.",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "618-257-4644"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036052179",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Okawville, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.