Healthcare Provider Details

I. General information

NPI: 1538955349
Provider Name (Legal Business Name): ORTHOPEDIC ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2025
Last Update Date: 04/17/2025
Certification Date: 04/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 ELEVEN S STE 3C
COLUMBIA IL
62236-1077
US

IV. Provider business mailing address

1050 OLD DES PERES RD STE 100
SAINT LOUIS MO
63131-1873
US

V. Phone/Fax

Practice location:
  • Phone: 314-569-0612
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: PAUL ROBERTS
Title or Position: CEO
Credential:
Phone: 314-569-0612