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General NPI Number Information
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NPI Number | 1225210222
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Entity Type | Organization
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Legal Business Name | PARKCREST ORTHOPEDICS LLC
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Dates
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Enumeration Date | 11/30/2007
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Last Update Date | 01/30/2008
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Provider Practice Location Address
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Address Line | 965 MATTOX DR
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City | SULLIVAN
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State | MO
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Zip | 63080-2365
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Country | US
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Telephone | 314-997-1777
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Fax | 314-997-6277
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Provider Business Mailing Address
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Address Line | 845 N NEW BALLAS CT STE 130
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City | SAINT LOUIS
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State | MO
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Zip | 63141-7134
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Country | US
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Telephone | 314-997-1777
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Fax | 314-997-6277
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MS. DEBBIE M STRAUSS
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Credential |
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Telephone | 314-997-1777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | R5H37
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License Number State | MO
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