1245283852 NPI number — ORTHOPEDIC & SPORTS MEDICINE EQUIPMENT & SUPPLY L L C

Table of content: DR. APRIL MICHELLE THOMSON D.O. (NPI 1336481522)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245283852 NPI number — ORTHOPEDIC & SPORTS MEDICINE EQUIPMENT & SUPPLY L L C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ORTHOPEDIC & SPORTS MEDICINE EQUIPMENT & SUPPLY L L C
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245283852
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/16/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1050 OLD DES PERES RD
Provider Second Line Business Mailing Address:
SUITE 60
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63131-1873
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-878-7030
Provider Business Mailing Address Fax Number:
314-878-6011

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1050 OLD DES PERES RD
Provider Second Line Business Practice Location Address:
SUITE 60
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63131-1873
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-878-7030
Provider Business Practice Location Address Fax Number:
314-878-6011
Provider Enumeration Date:
05/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GOLDSMITH
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
C
Authorized Official Title or Position:
PRESIDENT/OWNER
Authorized Official Telephone Number:
314-878-7030

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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