Provider Demographics
NPI:1063484400
Name:ST LOUIS ORTHOPEDIC SURGERY, INC
Entity Type:Organization
Organization Name:ST LOUIS ORTHOPEDIC SURGERY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DELEGATED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:SCHWARZE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-983-0088
Mailing Address - Street 1:2821 N BALLAS RD STE C15
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-2300
Mailing Address - Country:US
Mailing Address - Phone:314-989-0300
Mailing Address - Fax:
Practice Address - Street 1:2821 N BALLAS RD
Practice Address - Street 2:SUITE C-15
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-2321
Practice Address - Country:US
Practice Address - Phone:314-983-0088
Practice Address - Fax:314-983-9650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-01
Last Update Date:2018-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR7J25207X00000X
MOR9G33207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1306980002Medicare NSC
MO000013174Medicare PIN