Provider Demographics
NPI:1881887297
Name:PARKWAY ORTHOPAEDIC GROUP INC
Entity type:Organization
Organization Name:PARKWAY ORTHOPAEDIC GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KYU
Authorized Official - Middle Name:SOP
Authorized Official - Last Name:CHO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-569-1830
Mailing Address - Street 1:11330 S 40 DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-2555
Mailing Address - Country:US
Mailing Address - Phone:314-569-1830
Mailing Address - Fax:314-983-9922
Practice Address - Street 1:11330 S 40 DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-2555
Practice Address - Country:US
Practice Address - Phone:314-569-1830
Practice Address - Fax:314-983-9922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-20
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO33982207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
21203OtherBLUE CROSS BLUE SHIELD
IL5830160033Medicaid
4057743OtherAETNA
100215OtherHEALTHLINK
P00230577OtherRR MEDICARE
=========OtherTRICARE
4057743OtherAETNA
ILK05349Medicare UPIN
=========OtherTRICARE