Healthcare Provider Details

I. General information

NPI: 1588827224
Provider Name (Legal Business Name): CENTRAL ORTHOPEDICS AND SPORTS MEDICINE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2008
Last Update Date: 04/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 SAINT LUKES CENTER DR STE 502
CHESTERFIELD MO
63017-3519
US

IV. Provider business mailing address

PO BOX 1125
MARYLAND HEIGHTS MO
63043-0125
US

V. Phone/Fax

Practice location:
  • Phone: 314-275-7800
  • Fax:
Mailing address:
  • Phone: 314-275-7800
  • Fax: 314-275-7801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number2004010786
License Number StateMO

VIII. Authorized Official

Name: KRISTY MITCHELL
Title or Position: OFFICE MANAGER
Credential:
Phone: 314-275-7800