Organization
GRANITE CITY ORTHOPEDIC PHYSICIANS COMPANY LLC
Active
Parent organization
GRANITE CITY ORTHOPEDIC PHYSICIANS COMPANY LLC
Other names
Illinois SW Orthopedics
Organization subpart
Yes
Provider details
NPI number
Legal business name
GRANITE CITY ORTHOPEDIC PHYSICIANS COMPANY LLC
Authorized official
LAURA J FEY (SR. DIRECTOR PHYSICIAN REV CYCLE)
(615) 221-3641
Entity
Organization
Contact information
Practice address
4802 S STATE ROUTE 159, GLEN CARBON, IL 62034-1904
(618) 288-4388
(618) 288-4927
Mailing address
4802 S STATE ROUTE 159, GLEN CARBON, IL 62034-1904
(618) 288-4388
(618) 288-4927
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
504042508
—
MO
01
—
6032134
BCBS GROUP #
IL
Enumeration date
11/08/2007
Last updated
07/07/2023
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