Provider Demographics
NPI:1538360276
Name:GIEDD, SADIE OCHS (DO)
Entity type:Individual
Prefix:
First Name:SADIE
Middle Name:OCHS
Last Name:GIEDD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:SADIE
Other - Middle Name:OCHS
Other - Last Name:HOLLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 505164
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63150-5164
Mailing Address - Country:US
Mailing Address - Phone:417-829-4620
Mailing Address - Fax:417-829-4316
Practice Address - Street 1:1229 E SEMINOLE ST
Practice Address - Street 2:SUITE 320
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-2227
Practice Address - Country:US
Practice Address - Phone:417-820-2064
Practice Address - Fax:417-820-8716
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006031056208VP0014X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1538360276Medicaid
BP1-0026371OtherINSTITUTIONAL PERMIT
MO132680598Medicare PIN
MO132300558Medicare PIN