Basic Information
| Provider Information | |||||||||
| NPI: | 1063484400 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ST LOUIS ORTHOPEDIC SURGERY, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2821 N BALLAS RD STE C15 | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631312300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3149890300 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2821 N BALLAS RD | ||||||||
| Address2: | SUITE C-15 | ||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631312321 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3149830088 | ||||||||
| FaxNumber: | 3149839650 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/01/2006 | ||||||||
| LastUpdateDate: | 12/09/2018 | ||||||||
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| AuthorizedOfficialLastName: | SCHWARZE | ||||||||
| AuthorizedOfficialFirstName: | DANIEL | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | DELEGATED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 3149830088 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | R7J25 | MO | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | R9G33 | MO | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.