Provider Demographics
NPI:1356442396
Name:B & H ORTHOPEDIC LAB INC.
Entity Type:Organization
Organization Name:B & H ORTHOPEDIC LAB INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:K
Authorized Official - Last Name:HAMMER
Authorized Official - Suffix:
Authorized Official - Credentials:CO
Authorized Official - Phone:314-647-1617
Mailing Address - Street 1:2510 HAMPTON AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63139-2911
Mailing Address - Country:US
Mailing Address - Phone:314-647-1617
Mailing Address - Fax:314-647-4112
Practice Address - Street 1:2510 HAMPTON AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63139-2911
Practice Address - Country:US
Practice Address - Phone:314-647-1617
Practice Address - Fax:314-647-4112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO620074609Medicaid
MO105427OtherANTHEM
MO105427OtherANTHEM