Healthcare Provider Details

I. General information

NPI: 1912032020
Provider Name (Legal Business Name): ORTHOPEDIC ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 09/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 314-569-0612
  • Fax: 314-966-0664
Mailing address:
  • Phone: 314-569-0612
  • Fax: 314-966-0664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. LARRY W POLLEY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 314-714-3033