MEDICARE: ORTHOPEDIC SPECIALISTS, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	2005025486	MO
2	207X00000X	Orthopaedic Surgery Physician	R8G14	MO
3	207X00000X	Orthopaedic Surgery Physician	R1F60	MO
4	207X00000X	Orthopaedic Surgery Physician	112753	MO
5	207X00000X	Orthopaedic Surgery Physician	2003002791	MO
6	207X00000X	Orthopaedic Surgery Physician	105231	MO

General Provider Information

NPI Number	:	1063483816
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORTHOPEDIC SPECIALISTS, PC

Provider Business Mailing Address
First Line	:	PO BOX 790051
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63179-0051
Country	:	US
Telephone Number	:	314-989-0300
Fax Number	:

Provider Business Practice Location Address
First Line	:	2325 DOUGHERTY FERRY RD
Second Line	:	SUITE 200
City	:	SAINT LOUIS
State	:	MO
Zip	:	63122-3356
Country	:	US
Telephone Number	:	314-909-1359
Fax Number	:	314-909-1370

Authorized Official
Title or Position	:	DELEGATED OFFICIAL
Name	:	MICHAEL CHABOT
Credential	:	DO
Telephone Number	:	314-909-1359

Provider Enumeration Date	:	01/30/2006
Last Update Date	:	10/17/2007

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