PROACTIVE MD IL SC - NPI 1881488773 - Clinic/Center in O Fallon, IL

Q: What is the provider's specialty?

The provider's specialty is Clinic/Center with taxonomy code 261QP2300X and a focus in Primary Care.

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About Proactive Md Il Sc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PROACTIVE MD IL SC (NPI 1881488773), doing business as Oe 520 Health Center, is a healthcare organization registered as a primary care in O Fallon, Illinois and active in the NPI registry since April 2025. The organization lists Mark Kemble, Cmo, as its authorized official.

NPPES Registry Identity

NPI1881488773

Entity TypeOrganization

Primary Taxonomy261QP2300X

Legal Business NamePROACTIVE MD IL SC

Location Address1472 N GREEN MOUNT RDO Fallon, IL 62269-3416

Mailing Address124 Allawood CtSimpsonville, SC 29681-6207 · (864) 501-0751

Phone(730) 240-8040

Organization SubpartNo

Authorized OfficialMark KembleCmo · (864) 501-0751

Enumeration DateApril 7, 2025

NPPES CertifiedMarch 25, 2025

✔ NPI 1881488773 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Primary CareAmbulatory Health Care Facilities

Taxonomy Code261QP2300X

1472 N GREEN MOUNT RD, O Fallon, IL 62269

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Other Names 1

Doing Business AsOe 520 Health Center

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MEGAN KRISTINE YOUNG APRN, FNP-BC

Nurse Practitioner

1472 N GREEN MOUNT RD
O FALLON, IL 62269

St. Clair County (618) 680-0860

Frequently Asked Questions

What is PROACTIVE MD IL SC's NPI number?

The NPI number assigned to this healthcare provider is 1881488773, enumerated as an "organization" on April 07, 2025.

Where is the provider located?

The provider is located at 1472 N GREEN MOUNT RD O FALLON, IL 62269 and the phone number is (730) 240-8040.

What is the provider's specialty?

Clinic/Center with taxonomy code 261QP2300X and a focus in Primary Care.