Provider Demographics
NPI:1164692729
Name:SOUTH COUNTY ORTHOPEDICS AND SPORTS MEDICINE INC
Entity Type:Organization
Organization Name:SOUTH COUNTY ORTHOPEDICS AND SPORTS MEDICINE INC
Other - Org Name:MICHAEL RALPH, M.D.
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:HAROLD
Authorized Official - Last Name:RALPH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-849-7979
Mailing Address - Street 1:10004 KENNERLY RD STE 274B
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2177
Mailing Address - Country:US
Mailing Address - Phone:314-849-7979
Mailing Address - Fax:314-849-3555
Practice Address - Street 1:10004 KENNERLY RD STE 274B
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2177
Practice Address - Country:US
Practice Address - Phone:314-849-7979
Practice Address - Fax:314-849-3555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-10
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO201725439Medicaid
MO201725439Medicaid
0188110001Medicare NSC