Healthcare Provider Details

I. General information

NPI: 1881808483
Provider Name (Legal Business Name): THE ORTHOPEDIC CENTER OF ST LOUIS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 09/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14825 N OUTER 40 RD STE 200
CHESTERFIELD MO
63017-2152
US

IV. Provider business mailing address

14825 N OUTER FORTY STE 200
CHESTERFIELD MO
63017-2152
US

V. Phone/Fax

Practice location:
  • Phone: 314-336-2555
  • Fax: 314-336-2557
Mailing address:
  • Phone: 314-336-2555
  • Fax: 314-336-2557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DR. MITCHELL B ROTMAN
Title or Position: OWNER
Credential: M.D.
Phone: 314-336-2555