Provider Demographics
NPI:1245283852
Name:ORTHOPEDIC & SPORTS MEDICINE EQUIPMENT & SUPPLY L L C
Entity type:Organization
Organization Name:ORTHOPEDIC & SPORTS MEDICINE EQUIPMENT & SUPPLY L L C
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:GOLDSMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-878-7030
Mailing Address - Street 1:1050 OLD DES PERES RD
Mailing Address - Street 2:SUITE 60
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-1873
Mailing Address - Country:US
Mailing Address - Phone:314-878-7030
Mailing Address - Fax:314-878-6011
Practice Address - Street 1:1050 OLD DES PERES RD
Practice Address - Street 2:SUITE 60
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-1873
Practice Address - Country:US
Practice Address - Phone:314-878-7030
Practice Address - Fax:314-878-6011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO4681520001Medicare ID - Type Unspecified