Provider Demographics
NPI:1841574779
Name:COMMUNITY ORTHOPEDICS & SPORTS MEDICINE, PC
Entity Type:Organization
Organization Name:COMMUNITY ORTHOPEDICS & SPORTS MEDICINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:MS
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:C
Authorized Official - Last Name:ADDERLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-432-2580
Mailing Address - Street 1:PO BOX 1449
Mailing Address - Street 2:
Mailing Address - City:MARYLAND HEIGHTS
Mailing Address - State:MO
Mailing Address - Zip Code:63043-0449
Mailing Address - Country:US
Mailing Address - Phone:314-432-2580
Mailing Address - Fax:314-432-0223
Practice Address - Street 1:1101 WEBER RD
Practice Address - Street 2:SUITE 203
Practice Address - City:FARMINGTON
Practice Address - State:MO
Practice Address - Zip Code:63640-3352
Practice Address - Country:US
Practice Address - Phone:573-756-2600
Practice Address - Fax:573-756-2615
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY ORTHOPEDICS & SPORTS MEDICINE, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-10-11
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty