Organization
BI-STATE ORTHOTICS & PROSTHETICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL J NIEDER C.O. (VICE PRESIDENT)
(314) 843-2664
Entity
Organization
Contact information
Practice address
6400 W MAIN ST, SUITE 3G, BELLEVILLE, IL 62223-3806
(314) 843-2664
(314) 842-3866
Mailing address
12660 LAMPLIGHTER SQR SHPPNG CTR, SUITE J, SAINT LOUIS, MO 63128-2761
(314) 843-2664
(314) 842-3866
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
122758
BCBS OF MO
MO
01
—
8221629
BCBS OF IL
IL
Enumeration date
02/12/2007
Last updated
06/26/2008
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