Provider Demographics
NPI:1669657714
Name:THE ORTHOPEDIC CENTER OF ST. LOUIS
Entity type:Organization
Organization Name:THE ORTHOPEDIC CENTER OF ST. LOUIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:KAEPP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-336-2555
Mailing Address - Street 1:14825 N OUTER 40
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-2152
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14825 N OUTER 40
Practice Address - Street 2:SUITE 200
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-2152
Practice Address - Country:US
Practice Address - Phone:314-336-2555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOBG2076734174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOG59245Medicare UPIN
MOG65534Medicare UPIN
MOG69623Medicare UPIN
MOC72129Medicare UPIN
MOG82897Medicare UPIN
MOE48218Medicare UPIN
MOF27083Medicare UPIN
MOG11607Medicare UPIN
MOG20068Medicare UPIN