Active NPI
OB Practice, LLC
- Obstetrics & Gynecology Physician
- Belleville, IL
National Provider Identifier
1629386586
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Obstetrics & Gynecology Physician
- Legal business name
- OB PRACTICE, LLC
- Practice address
- 4600 Memorial Drive
Ste. 400
Belleville, IL 62226 - Phone
- (618) 234-2390
- Fax
- (618) 234-9936
- NPI assigned
- Sep 14, 2010
- Last updated
- Jul 21, 2022
- Organization subpart
- Yes
- Parent organization
- OB PRACTICE, LLC
NPPES NPI Registry
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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Obstetrics & Gynecology Physician | 207V00000X | Primary | ||
| Gynecology Physician | 207VG0400X |
Addresses
Primary practice location
4600 Memorial Drive
Ste. 400
Belleville, IL 62226
Mailing address
4500 Memorial Dr
Medical Affairs Credentialing Department
Belleville, IL 62226-5360
Phone (618) 257-4644
Other practice location 1
4600 Memorial Dr Ste 240
Belleville, IL 62226-5363
Phone (618) 234-2390
National Provider Directory
National Provider Directory- Part of
- OB Practice LLC
Locations
1404 Cross St
Fl 3
Shiloh, IL 62269
Phone (618) 607-3800
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1284422400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1658361600000",
"number": "1629386586",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4500 MEMORIAL DR",
"address_2": "MEDICAL AFFAIRS CREDENTIALING DEPARTMENT",
"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": "4600 MEMORIAL DRIVE",
"address_2": "STE. 400",
"city": "BELLEVILLE",
"state": "IL",
"postal_code": "62226",
"telephone_number": "618-234-2390",
"fax_number": "618-234-9936"
}
],
"practiceLocations": [
{
"address_1": "4600 Memorial Dr Ste 240",
"address_purpose": "LOCATION",
"city": "Belleville",
"state": "IL",
"postal_code": "622265363",
"country_code": "US",
"telephone_number": "618-234-2390",
"fax_number": "618-234-9936",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"organization_name": "OB PRACTICE, LLC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "OB PRACTICE, LLC",
"enumeration_date": "2010-09-14",
"last_updated": "2022-07-21",
"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": "207V00000X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology",
"state": null,
"license": null,
"primary": true
},
{
"code": "207VG0400X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology, Gynecology",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Belleville, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.