Provider Demographics
NPI:1619292950
Name:BELLEVILLE ORTHOPEDIC SURGEONS LTD
Entity Type:Organization
Organization Name:BELLEVILLE ORTHOPEDIC SURGEONS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:A
Authorized Official - Last Name:WEIMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:618-235-2900
Mailing Address - Street 1:4550 MEMORIAL DR
Mailing Address - Street 2:SUITE 460
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62226-5372
Mailing Address - Country:US
Mailing Address - Phone:618-235-2900
Mailing Address - Fax:618-235-2009
Practice Address - Street 1:4550 MEMORIAL DR
Practice Address - Street 2:SUITE 460
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62226-5372
Practice Address - Country:US
Practice Address - Phone:618-235-2900
Practice Address - Fax:618-235-2009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-30
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036101574174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036101574OtherILLINOIS LICENSE NUMBER