Provider Demographics
NPI:1023144896
Name:NORTH COUNTY ORTHOPAEDICS, INC.
Entity type:Organization
Organization Name:NORTH COUNTY ORTHOPAEDICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:H
Authorized Official - Last Name:BRANCATO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-355-7717
Mailing Address - Street 1:11863 BENHAM RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63138-1308
Mailing Address - Country:US
Mailing Address - Phone:314-355-7717
Mailing Address - Fax:314-355-8688
Practice Address - Street 1:11863 BENHAM RD
Practice Address - Street 2:SUITE 102
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63138-1308
Practice Address - Country:US
Practice Address - Phone:314-355-7717
Practice Address - Fax:314-355-8688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR5454174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO137229OtherPHCS
MO5368OtherBLUE CROSS BLUE SHIELD
MO09-00007OtherUNITED HEALTHCARE
MO1254OtherGROUP HEALTH PLAN
MO4000123OtherAETNA
MO03822Medicare ID - Type Unspecified
MO4000123OtherAETNA