1669578225 NPI number — CHESTERFIELD ORTHOPEDICS, PC

Table of content: (NPI 1669578225)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669578225 NPI number — CHESTERFIELD ORTHOPEDICS, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHESTERFIELD ORTHOPEDICS, PC
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:
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:
1669578225
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/19/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
222 SOUTH WOODS MILL ROAD
Provider Second Line Business Mailing Address:
SUITE 650 NORTH MEDICAL BUILDING
Provider Business Mailing Address City Name:
CHESTERFIELD
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63017-3625
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-317-9000
Provider Business Mailing Address Fax Number:
314-275-8372

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
222 SOUTH WOODS MILL ROAD
Provider Second Line Business Practice Location Address:
SUITE 650 NORTH MEDICAL BUILDING
Provider Business Practice Location Address City Name:
CHESTERFIELD
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63017-3625
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-317-9000
Provider Business Practice Location Address Fax Number:
314-275-8372
Provider Enumeration Date:
09/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WALENTYNOWICZ
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PRESIDENT AND OWNER
Authorized Official Telephone Number:
314-317-9000

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  R4J48 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 200037794 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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