Provider Demographics
NPI:1851541106
Name:WEST COUNTY SPINE & SPORTS MEDICINE
Entity Type:Organization
Organization Name:WEST COUNTY SPINE & SPORTS MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:J
Authorized Official - Last Name:MARGHERITA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-432-4999
Mailing Address - Street 1:PO BOX 66936
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63166-6936
Mailing Address - Country:US
Mailing Address - Phone:314-432-2580
Mailing Address - Fax:314-432-0223
Practice Address - Street 1:555 NORTH NEW BALLAS RD
Practice Address - Street 2:SUITE 210
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141
Practice Address - Country:US
Practice Address - Phone:314-432-4999
Practice Address - Fax:314-432-5088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-23
Last Update Date:2019-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1131202081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOF04539Medicare UPIN
MOMA1457Medicare PIN