Provider Demographics
NPI:1467695999
Name:ORTHOPEDIC URGENT CARE OF AMERICA LLC
Entity Type:Organization
Organization Name:ORTHOPEDIC URGENT CARE OF AMERICA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:A
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:314-724-6064
Mailing Address - Street 1:10842 KENNERLY RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2031
Mailing Address - Country:US
Mailing Address - Phone:314-724-6064
Mailing Address - Fax:
Practice Address - Street 1:12152 TESSON FERRY RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-1726
Practice Address - Country:US
Practice Address - Phone:314-724-6064
Practice Address - Fax:314-849-2042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-14
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care