Provider Demographics
NPI:1427580992
Name:LANDCO ORTHOPEDICS LLC
Entity Type:Organization
Organization Name:LANDCO ORTHOPEDICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:LANDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-432-1211
Mailing Address - Street 1:3009 N BALLAS RD
Mailing Address - Street 2:SUITE 100B
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-2322
Mailing Address - Country:US
Mailing Address - Phone:314-432-1111
Mailing Address - Fax:314-786-0544
Practice Address - Street 1:689 CRAIG RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-7112
Practice Address - Country:US
Practice Address - Phone:314-432-1111
Practice Address - Fax:314-786-0544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-03
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR5920207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty