MEDICARE: WILLIAM JOSEPH GROUP, LLC

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	335E00000X	Prosthetic/Orthotic Supplier

General Provider Information

NPI Number	:	1245467265
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLIAM JOSEPH GROUP, LLC

Provider Business Mailing Address
First Line	:	12597 OLIVE BLVD
Second Line	:
City	:	CREVE COEUR
State	:	MO
Zip	:	63141-6311
Country	:	US
Telephone Number	:	314-205-0900
Fax Number	:	314-205-0905

Provider Business Practice Location Address
First Line	:	12597 OLIVE BLVD
Second Line	:
City	:	CREVE COEUR
State	:	MO
Zip	:	63141-6311
Country	:	US
Telephone Number	:	314-205-0900
Fax Number	:	314-205-0905

Authorized Official
Title or Position	:	OWNER
Name	:	MR. WILLIAM WIRZ
Credential	:
Telephone Number	:	314-205-0900

Provider Enumeration Date	:	06/17/2009
Last Update Date	:	01/07/2010

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