Provider Demographics
NPI:1265614549
Name:JAMES B O'NEAL, MS AMD ASSOCIATES, PC
Entity type:Organization
Organization Name:JAMES B O'NEAL, MS AMD ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:BRADLEY
Authorized Official - Last Name:O'NEAL
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:618-263-3322
Mailing Address - Street 1:114 W 8TH ST
Mailing Address - Street 2:PO BOX 681
Mailing Address - City:MOUNT CARMEL
Mailing Address - State:IL
Mailing Address - Zip Code:62863-1443
Mailing Address - Country:US
Mailing Address - Phone:618-263-3322
Mailing Address - Fax:618-263-3322
Practice Address - Street 1:114 W 8TH ST
Practice Address - Street 2:
Practice Address - City:MOUNT CARMEL
Practice Address - State:IL
Practice Address - Zip Code:62863-1443
Practice Address - Country:US
Practice Address - Phone:618-263-3322
Practice Address - Fax:618-263-3322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)