# COMMUNITY ORTHOPEDICS & SPORTS MEDICINE, PC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** COMMUNITY ORTHOPEDICS & SPORTS MEDICINE, PC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1710261623
- **Legal business name:** COMMUNITY ORTHOPEDICS & SPORTS MEDICINE, PC
- **Authorized official:** MS. TAMMY ADDERLEY (CREDENTIALING)
- **Authorized official phone:** (314) 432-2580

## Contact information

- **Practice address:** 818 E BROADWAY ST, 1ST FLOOR, SPARTA, IL 62286-1820
- **Practice address phone:** (618) 443-2177
- **Practice address fax:** (618) 443-1324
- **Mailing address:** PO BOX 1449, MARYLAND HEIGHTS, MO 63043-0449
- **Mailing address phone:** (314) 432-2580
- **Mailing address fax:** (314) 432-0223

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | 036109093 | IL | Yes |

## Other

- **Enumeration date:** 10/11/2011
- **Last updated:** 10/11/2011