OB GYN CARE LLC (NPI# 1790945103) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790945103 |
| Entity Type | Organization |
| Organization Name | OB GYN CARE LLC |
| Practice Address |
1512 N Green Mount Rd Suite 107 O Fallon IL 62269-1953 |
| Practice Telephone | 6186281717 |
| Practice Fax Number | 6186281789 |
| Mailing Telephone | 6186281717 |
| Mailing Fax Number | 6186281789 |
| Enumeration Date | 2008-06-10 |
| Last Update Date | 2008-06-10 |
| Authorized Official Name | DR. BRADLEY J TISSIER (MEMBER) |
| Authorized Official Telephone | 6186281717 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 208600000X | Surgery | 036097979 | IL | Allopathic & Osteopathic Physicians |
| Y | 207V00000X | Obstetrics & Gynecology | 036097979 | IL | Allopathic & Osteopathic Physicians |
| Street Address |
1512 N GREEN MOUNT RD SUITE 107 |
| City | O FALLON |
| State | IL |
| Zip Code | 62269-1953 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891787040 | Dorrie C Tredway | Family Medicine | 1512 N Green Mount Rd, Suite 108, O Fallon, IL 62269-2083 | 2005-08-15 |
| 1487142022 | Vituity - Illinois Auc LLP | Emergency Medicine | 1512 N Green Mount Rd, O Fallon, IL 62269 | 2018-04-30 |
| 1295239747 | Chandler Sparks | Student in an Organized Health Care Education/Training Program | 1512 N Green Mount Rd, O Fallon, IL 62269-2083 | 2018-03-20 |
| 1649660200 | Tara Topper | Nurse Practitioner | 1512 N Green Mount Rd, O Fallon, IL 62269-1953 | 2015-02-03 |
| 1851715692 | Infinity-meds LLP | Emergency Medicine | 1512 N Green Mount Rd, O Fallon, IL 62269-1953 | 2014-02-14 |
| 1639319387 | David Edward Bereda | Family Medicine | 1512 N Green Mount Rd, O Fallon, IL 62269-2083 | 2009-02-20 |
| 1053587402 | Amy Marie Buck | Nurse Practitioner | 1512 N Green Mount Rd, Suite 200, O Fallon, IL 62269-1953 | 2008-05-06 |
| 1932377249 | Stephen Jubinski Jr. | Family Medicine | 1512 N Green Mount Rd, Suite 108, O Fallon, IL 62269-1953 | 2008-02-20 |
| 1003091570 | St. Elizabeth Hospital | Clinic/Center | 1512 N Green Mount Rd, Suite 200, O Fallon, IL 62269-1953 | 2008-01-03 |
| 1184758963 | Michelle Mcpherson | Physical Therapist | 1512 N Green Mount Rd, O Fallon, IL 62269-1953 | 2007-03-15 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326648155 | Kayla Revermann | Pharmacist | 1350 W Us Highway 50, Pharmacy, O Fallon, IL 62269 | 2020-10-30 |
| 1942814272 | Ashley Monique Gibson | Behavior Technician | Eagle Center, Ste 10, Ofallon, IL 62269 | 2020-09-03 |
| 1013533819 | Michelle Denise Voudrie | Registered Nurse | 321 Regency Park, O'fallon, IL 62269 | 2020-06-18 |
| 1598398455 | Washington University Physicians In Illinois - Cancer Center Pharmacy | Pharmacy | 1418 Cross Street, Suite 180, Shiloh, IL 62269 | 2020-02-19 |
| 1962063800 | Gerald Paskert | Pharmacist | 122 W. State St., O'fallon, IL 62269 | 2019-06-21 |
| 1780144808 | Bonnie Jean Lampe | Physical Therapy Assistant | 316 Donna Dr, O'fallon, IL 62269 | 2019-03-24 |
| 1134633993 | Latisha Smith | Psychologist | 600 S. Smiley St., O'fallon, IL 62269 | 2017-11-30 |
| 1619407210 | Brenna M Thomas | Registered Nurse | 1310 Engle Ct, O'fallon, IL 62269 | 2017-06-15 |
| 1881135622 | Pc Associates, LLC | Family Medicine | 800 East Highway 50, O'fallon, IL 62269 | 2017-03-13 |
| 1700230539 | Jennifer Farrell | Family Medicine | 3 St. Elizabeth's Blvd, Ste. 4000, O'fallon, IL 62269 | 2016-04-18 |
| Find all providers in zip 62269 | ||||
| Taxonomy Code | 207V00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Obstetrics & Gynecology |
| An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Obstetrics and Gynecology, 2007. http://www.abog.org/. American Osteopathic Board of Obstetrics and Gynecology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Obstetrics and Gynecology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Obstetrics and Gynecology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326484742 | Emma Rose Eubanks | Obstetrics & Gynecology | 1101 State Highway K, O Fallon, MO 63366 | 2013-05-13 |
| 1508067596 | Christina H Dothager | Obstetrics & Gynecology | 787 Sunset Blvd Ste 200, O Fallon, IL 62269-1960 | 2007-05-29 |
| 1669673653 | Anne Rebecca Seyer | Obstetrics & Gynecology | 20 Progress Point Pkwy Ste 206, O Fallon, MO 63368-2207 | 2007-05-29 |
| 1477585669 | Julia Gale Hoffman | Obstetrics & Gynecology | 20 Progress Point Pkwy Ste 126, O Fallon, MO 63368-2207 | 2006-07-07 |
| 1427027515 | Kirsten M Mcdaniel | Obstetrics & Gynecology | 20 Progress Point Pkwy Ste 200, O Fallon, MO 63368-2207 | 2006-03-14 |
| 1407837982 | P Douglas Young Jr. | Obstetrics & Gynecology | 1101 Highway K, O Fallon, MO 63366-8431 | 2005-11-10 |
| 1730174277 | Rosel Hirang Calong | Obstetrics & Gynecology | 800 E Highway 50, O Fallon, IL 62269-2844 | 2005-09-12 |
| 1447696802 | Thomas Frederic Ganz | Obstetrics & Gynecology | 1101 Highway K, O Fallon, MO 63366-8431 | 2013-05-13 |
| 1790028520 | Lindsay Ann Murphy Dickerhoff | Obstetrics & Gynecology | 1101 Highway K, O Fallon, MO 63366-8431 | 2013-03-29 |
| 1417211756 | Nikol Lei Smart | Obstetrics & Gynecology | 20 Progress Point Pkwy, Ste 206, O Fallon, MO 63368-2206 | 2012-07-02 |
| Find all providers in O FALLON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.