Provider Demographics
NPI:1477511251
Name:VINCENT SOLLECITO,III
Entity Type:Organization
Organization Name:VINCENT SOLLECITO,III
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLLECITO,
Authorized Official - Suffix:III
Authorized Official - Credentials:DPM
Authorized Official - Phone:314-352-2711
Mailing Address - Street 1:3915 WATSON RD
Mailing Address - Street 2:#200
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63109-1251
Mailing Address - Country:US
Mailing Address - Phone:314-352-2711
Mailing Address - Fax:314-644-5081
Practice Address - Street 1:3915 WATSON
Practice Address - Street 2:#200
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63109-1251
Practice Address - Country:US
Practice Address - Phone:314-352-2711
Practice Address - Fax:314-644-5081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000449213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO302805007Medicaid
MO000021198Medicare ID - Type Unspecified
MOT80995Medicare UPIN
MO1251500001Medicare NSC