Healthcare Provider Details

I. General information

NPI: 1225182157
Provider Name (Legal Business Name): ST PETERS BONE & JOINT SURGERY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 03/16/2025
Certification Date: 03/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5200 EXECUTIVE CENTRE PKWY STE 300
SAINT PETERS MO
63376-3809
US

IV. Provider business mailing address

PO BOX 430
SAINT PETERS MO
63376-0008
US

V. Phone/Fax

Practice location:
  • Phone: 636-441-3444
  • Fax: 636-441-9832
Mailing address:
  • Phone: 636-441-3444
  • Fax: 636-441-9832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number StateMO
# 5
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JIM KIDD
Title or Position: CEO
Credential:
Phone: 636-441-3444