Organization
COMMUNITY ORTHOPEDICS & SPORTS MEDICINE, PC
Active
Parent organization
COMMUNITY ORTHOPEDICS & SPORTS MEDICINE, PC
Organization subpart
Yes
Provider details
NPI number
Legal business name
COMMUNITY ORTHOPEDICS & SPORTS MEDICINE, PC
Authorized official
MS. TAMMY ADDERLEY (CREDENTIALING)
(314) 432-2580
Entity
Organization
Contact information
Practice address
818 E BROADWAY ST, 1ST FLOOR, SPARTA, IL 62286-1820
(618) 443-2177
(618) 443-1324
Mailing address
PO BOX 1449, MARYLAND HEIGHTS, MO 63043-0449
(314) 432-2580
(314) 432-0223
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
036109093
IL
Other
Enumeration date
10/11/2011
Last updated
10/11/2011
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