Provider Demographics
NPI:1427124148
Name:WILLIAM SEDGWICK MD ORTHOPAEDIC SURGERY AND SPORTS MEDICINE PC
Entity type:Organization
Organization Name:WILLIAM SEDGWICK MD ORTHOPAEDIC SURGERY AND SPORTS MEDICINE PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:GLENN
Authorized Official - Last Name:SEDGWICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-878-6001
Mailing Address - Street 1:226 S WOODS MILL
Mailing Address - Street 2:SUITE 47W
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017
Mailing Address - Country:US
Mailing Address - Phone:314-878-6001
Mailing Address - Fax:314-878-2709
Practice Address - Street 1:226 S WOODS MILL
Practice Address - Street 2:SUITE 47W
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017
Practice Address - Country:US
Practice Address - Phone:314-878-6001
Practice Address - Fax:314-878-2709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2010-09-30
Deactivation Date:2008-07-10
Deactivation Code:
Reactivation Date:2010-09-30
Provider Licenses
StateLicense IDTaxonomies
MOR7073207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000000170Medicare PIN
A14064Medicare UPIN