Healthcare Provider Details

I. General information

NPI: 1982606273
Provider Name (Legal Business Name): PRECISION PROSTHETICS & ORTHOTICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11102 LINDBERGH BUSINESS CT
SAINT LOUIS MO
63123-7810
US

IV. Provider business mailing address

11102 LINDBERGH BUSINESS CT
SAINT LOUIS MO
63123-7810
US

V. Phone/Fax

Practice location:
  • Phone: 314-843-3339
  • Fax: 314-843-1119
Mailing address:
  • Phone: 314-843-3339
  • Fax: 314-843-1119

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: CASSIE MCCORMACK
Title or Position: BUSINESS MANAGER
Credential:
Phone: 314-843-3339