Provider Demographics
NPI:1295159184
Name:CA GROUP, LLC
Entity type:Organization
Organization Name:CA GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:B
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-257-4644
Mailing Address - Street 1:4017 ILLINOIS ROUTE 159
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SMITHTON
Mailing Address - State:IL
Mailing Address - Zip Code:62285
Mailing Address - Country:US
Mailing Address - Phone:618-257-2875
Mailing Address - Fax:618-257-2895
Practice Address - Street 1:4017 ILLINOIS ROUTE 159
Practice Address - Street 2:SUITE 101
Practice Address - City:SMITHTON
Practice Address - State:IL
Practice Address - Zip Code:62285
Practice Address - Country:US
Practice Address - Phone:618-257-2875
Practice Address - Fax:618-257-2895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-12
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty