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General NPI Number Information
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NPI Number | 1356853683
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Entity Type | Organization
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Legal Business Name | ORTHOPEDIC AND SPINE INSTITUTE OF ST. LOUIS, LLC
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Dates
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Enumeration Date | 10/26/2017
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Last Update Date | 02/07/2019
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Provider Practice Location Address
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Address Line | 10435 CLAYTON RD STE 120
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City | SAINT LOUIS
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State | MO
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Zip | 63131
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Country | US
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Telephone | 314-442-4452
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Fax | 866-216-3928
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Provider Business Mailing Address
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Address Line | 10435 CLAYTON RD STE 120
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City | SAINT LOUIS
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State | MO
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Zip | 63131-2930
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Country | US
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Telephone | 314-442-4452
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Fax | 866-216-3928
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | MICHELLE R DICKISON
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Credential | RN
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Telephone | 314-808-3173
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XS0117X
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Taxonomy Name | Orthopaedic Surgery of the Spine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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