Provider Demographics
NPI:1437272663
Name:ST. LOUIS-CLAYTON ORTHOPEDIC GROUP, INC.
Entity Type:Organization
Organization Name:ST. LOUIS-CLAYTON ORTHOPEDIC GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:P
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-721-7325
Mailing Address - Street 1:1034 S BRENTWOOD BLVD STE 650
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-1267
Mailing Address - Country:US
Mailing Address - Phone:314-721-7325
Mailing Address - Fax:314-721-1157
Practice Address - Street 1:1034 S BRENTWOOD BLVD STE 650
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117-1267
Practice Address - Country:US
Practice Address - Phone:314-721-7325
Practice Address - Fax:314-721-1157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000011284Medicare PIN
IL216628Medicare PIN