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General NPI Number Information
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NPI Number | 1750461067
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Entity Type | Organization
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Legal Business Name | THE ORTHOPEDIC CENTER OF ST. LOUIS
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Dates
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Enumeration Date | 10/17/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 14825 N OUTER 40 SUITE 200
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City | CHESTERFIELD
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State | MO
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Zip | 63017-2152
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Country | US
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Telephone | 314-336-2555
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Fax | 314-336-2557
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Provider Business Mailing Address
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Address Line | 14825 N OUTER 40 SUITE 200
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City | CHESTERFIELD
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State | MO
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Zip | 63017-2152
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Country | US
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Telephone | 314-336-2555
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Fax | 314-336-2557
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Authorized Official
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Title or Position | FINANCIALS
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Name | TAMMY MATTINGLY
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Credential |
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Telephone | 314-336-2620
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 36909
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License Number State | MO
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