Provider Demographics
NPI:1346594652
Name:ST. CHARLES ORTHOPAEDIC SURGERY ASSOCIATES, INC.
Entity Type:Organization
Organization Name:ST. CHARLES ORTHOPAEDIC SURGERY ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:SCHABERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:636-561-5030
Mailing Address - Street 1:9323 PHOENIX VILLAGE PKWY
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-4281
Mailing Address - Country:US
Mailing Address - Phone:636-561-5030
Mailing Address - Fax:636-561-5033
Practice Address - Street 1:5301 VETERANS MEMORIAL PKWY
Practice Address - Street 2:STE 104
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-2298
Practice Address - Country:US
Practice Address - Phone:636-561-5030
Practice Address - Fax:636-561-5033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-08
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO990000528Medicare PIN