Provider Demographics
NPI:1386778660
Name:ORTHOPEDIC CARE OF ST. LOUIS, PC
Entity type:Organization
Organization Name:ORTHOPEDIC CARE OF ST. LOUIS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:W
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-434-0030
Mailing Address - Street 1:1040 N MASON RD
Mailing Address - Street 2:SUITE G03
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6399
Mailing Address - Country:US
Mailing Address - Phone:314-434-0030
Mailing Address - Fax:314-434-0009
Practice Address - Street 1:1040 N MASON RD
Practice Address - Street 2:SUITE G03
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6399
Practice Address - Country:US
Practice Address - Phone:314-434-0030
Practice Address - Fax:314-434-0009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MODD5877OtherRR MEDICARE
MO4882960001Medicare NSC
MO000013842Medicare PIN