Healthcare Provider Details

I. General information

NPI: 1487900684
Provider Name (Legal Business Name): ST. LOUIS BONE AND JOINT CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2012
Last Update Date: 08/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8000 GRAVOIS RD
SAINT LOUIS MO
63123-4721
US

IV. Provider business mailing address

8000 GRAVOIS RD
SAINT LOUIS MO
63123-4721
US

V. Phone/Fax

Practice location:
  • Phone: 314-351-2500
  • Fax:
Mailing address:
  • Phone: 314-351-2500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number2012023237
License Number StateMO

VIII. Authorized Official

Name: DR. ERIC WILLIAM WERNER
Title or Position: PRESIDENT
Credential: DC, MPH
Phone: 314-351-2500