Organization
ST CLAIR ORTHOPEDICS, SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHAD SACKMAN (ADMINISTRATOR)
(314) 849-0311
Entity
Organization
Contact information
Practice address
33 BRONZE POINTE BLVD, SUITE 100, SWANSEA, IL 62226-8311
(618) 257-1177
(618) 257-1184
Mailing address
12639 OLD TESSON RD, SUITE 115, SAINT LOUIS, MO 63128-2786
(314) 849-0311
(314) 849-4423
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
263758
GROUP HEALTHPLAN
IL
01
—
761576
AETNA
IL
Enumeration date
06/30/2006
Last updated
10/29/2010
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