NPIMap

Organization Active NPI

Oa Associated LLC

Doing business as Southern Illinois Sports Medicine

  • Athletic Trainer
  • Belleville, IL
National Provider Identifier
1699061259
Registry record updated Jun 22, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Athletic TrainerTaxonomy code 2255A2300X
License
096002594 Issued in IL
Legal business name
OA ASSOCIATED LLC
Doing business as
Southern Illinois Sports Medicine
Practice address
4550 Memorial Dr
Moc-1, Suite G-100
Belleville, IL 62226-5372
Phone
(618) 236-2246
Fax
(618) 236-2315
NPI assigned
Jun 22, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 22, 2011

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

Authorized official

Name
Jason Daniel Noeldner, ATC,LAT
Title
Athletic Trainer
Phone
(618) 236-2246

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Athletic TrainerGroup: 193400000X SINGLE SPECIALTY GROUP 2255A2300X 096002594 IL Primary

Addresses

Primary practice location

4550 Memorial Dr
Moc-1, Suite G-100
Belleville, IL 62226-5372

Mailing address

4550 Memorial Dr
Moc-1, Suite G-100
Belleville, IL 62226-5372
Phone (618) 236-2246

Other names 1

  • Southern Illinois Sports Medicine Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Oa Associates LLC Dba Orthopedic and Sports Medicine LTD13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

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

Locations

4550 Memorial Dr
Ste G100
Belleville, IL 62226
Phone (608) 236-2246

NPI Registry JSON

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

{
    "created_epoch": "1308700800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1308700800000",
    "number": "1699061259",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4550 MEMORIAL DR",
            "address_2": "MOC-1, SUITE G-100",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622265372",
            "telephone_number": "618-236-2246",
            "fax_number": "618-236-2315"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4550 MEMORIAL DR",
            "address_2": "MOC-1, SUITE G-100",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622265372",
            "telephone_number": "618-236-2246",
            "fax_number": "618-236-2315"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OA ASSOCIATED LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-22",
        "last_updated": "2011-06-22",
        "status": "A",
        "authorized_official_last_name": "NOELDNER",
        "authorized_official_first_name": "JASON",
        "authorized_official_middle_name": "DANIEL",
        "authorized_official_title_or_position": "ATHLETIC TRAINER",
        "authorized_official_telephone_number": "618-236-2246",
        "authorized_official_credential": "ATC,LAT"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "IL",
            "license": "096002594",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southern Illinois Sports Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Jun 22, 2011; 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.