Parkcrest Orthopedics LLC

Primary specialty

Orthopaedic Surgery PhysicianTaxonomy code 207X00000X

License

036118660 Issued in IL

Legal business name

PARKCREST ORTHOPEDICS LLC

Practice address

509 Hamacher St
Ste 202
Waterloo, IL 62298-1592

Phone

(314) 997-1777

Fax

(314) 997-6277

NPI assigned

May 10, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Kim Uzzetta

Title

Practice Manager

Phone

(314) 997-1777

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Parkcrest Orthopedic LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Parkcrest Orthopedics LLC

  • Orthopaedic Surgery Physician
  • Farmington, MO
  • NPI 1568860641
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1336608000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1336608000000",
    "number": "1346509403",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "845 N NEW BALLAS CT",
            "address_2": "STE 130",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631417134",
            "telephone_number": "314-997-1777",
            "fax_number": "314-997-6277"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "509 HAMACHER ST",
            "address_2": "STE 202",
            "city": "WATERLOO",
            "state": "IL",
            "postal_code": "622981592",
            "telephone_number": "314-997-1777",
            "fax_number": "314-997-6277"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARKCREST ORTHOPEDICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-10",
        "last_updated": "2012-05-10",
        "status": "A",
        "authorized_official_last_name": "UZZETTA",
        "authorized_official_first_name": "KIM",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "314-997-1777",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthopaedic Surgery",
            "state": "IL",
            "license": "036118660",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP MEMBER NPI",
            "identifier": "1518968759",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ami Ruth Ogden, RSA
• Julia Mary Olszewski, COUNSELOR, QMHP
• Orthodontic Associates of Columbia and Waterloo
• Kimberly K Ott
• Thea Palermo, QMHP
• Kaitlyn Parkman, LCPC
• Larry Parsley, RN QMHP
• Kizzy Partee, RSA
• Molly C Paul-Munie, MA, CCC-SLP
• Linda Peck

• Orthopaedic Surgery Physician in Waterloo, IL
• Providers in Waterloo, IL by specialty
• Orthopaedic Surgery Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.