Organization
PARKCREST ORTHOPEDICS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KIM UZZETTA (PRACTICE MANAGER)
(314) 997-1777
Entity
Organization
Contact information
Practice address
509 HAMACHER ST, STE 202, WATERLOO, IL 62298-1592
(314) 997-1777
(314) 997-6277
Mailing address
845 N NEW BALLAS CT, STE 130, SAINT LOUIS, MO 63141-7134
(314) 997-1777
(314) 997-6277
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
036118660
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1518968759
GROUP MEMBER NPI
MO
Enumeration date
05/10/2012
Last updated
05/10/2012
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