MEDICARE: ST JOSEPH ORTHOPEDIC ASSOCIATES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician		MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	04974023	OTHER	MO	BCBS KC PIN
2	074632	OTHER	KS	BCBS KS PIN

General Provider Information

NPI Number	:	1013906635
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST JOSEPH ORTHOPEDIC ASSOCIATES INC

Provider Business Mailing Address
First Line	:	1335 VILLAGE DR
Second Line	:
City	:	SAINT JOSEPH
State	:	MO
Zip	:	64506-2457
Country	:	US
Telephone Number	:	800-875-0211
Fax Number	:	816-233-7258

Provider Business Practice Location Address
First Line	:	1335 VILLAGE DR
Second Line	:
City	:	SAINT JOSEPH
State	:	MO
Zip	:	64506-2457
Country	:	US
Telephone Number	:	800-875-0211
Fax Number	:	816-233-7258

Authorized Official
Title or Position	:	OWNER
Name	:	WILLIAM H GONDRING
Credential	:	MD
Telephone Number	:	800-875-0211

Provider Enumeration Date	:	10/17/2005
Last Update Date	:	07/21/2022

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1104848662 — DR. MICHAEL E. NELLESTEIN M.D.
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Directions to “ST JOSEPH ORTHOPEDIC ASSOCIATES INC ” Practice Location

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