Healthcare Provider Details

I. General information

NPI: 1386778660
Provider Name (Legal Business Name): ORTHOPEDIC CARE OF ST. LOUIS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 10/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 N MASON RD SUITE G03
SAINT LOUIS MO
63141-6399
US

IV. Provider business mailing address

1040 N MASON RD SUITE G03
SAINT LOUIS MO
63141-6399
US

V. Phone/Fax

Practice location:
  • Phone: 314-434-0030
  • Fax: 314-434-0009
Mailing address:
  • Phone: 314-434-0030
  • Fax: 314-434-0009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JEFFREY W MARTIN
Title or Position: PHYSICIAN, OWNER
Credential: M.D.
Phone: 314-434-0030