South St Louis Orthopedic Group Inc

Primary specialty

Orthopaedic Surgery PhysicianTaxonomy code 207X00000X

Legal business name

SOUTH ST LOUIS ORTHOPEDIC GROUP INC

Practice address

9815 Mackenzie Road
St Louis, MO 63123

Phone

(314) 638-8785

Fax

(314) 638-8788

NPI assigned

Nov 7, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Mitchell M Mirbaha, MDNPI 1275602005

Title

President

Phone

(314) 638-8785

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mitchell M Mirbaha, MD

  • Orthopaedic Surgery Physician
  • St Louis, MO
  • NPI 1275602005

  Orthopaedic Surgery

  NPD (past) Authorized official
• Brandon Allen Doser, D.P.M.

  • Foot & Ankle Surgery Podiatrist
  • Clayton, MO
  • NPI 1811284680
  NPD (past)
• Denise A Hardy, DPM

  • Podiatrist
  • St Louis, MO
  • NPI 1033122759
  NPD (past)

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

{
    "created_epoch": "1162857600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1222819200000",
    "number": "1831268663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9815 MACKENZIE ROAD",
            "city": "ST LOUIS",
            "state": "MO",
            "postal_code": "63123",
            "telephone_number": "314-638-8785",
            "fax_number": "314-638-8788"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9815 MACKENZIE ROAD",
            "city": "ST LOUIS",
            "state": "MO",
            "postal_code": "63123",
            "telephone_number": "314-638-8785",
            "fax_number": "314-638-8788"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH ST LOUIS ORTHOPEDIC GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-07",
        "last_updated": "2008-10-01",
        "status": "A",
        "authorized_official_last_name": "MIRBAHA",
        "authorized_official_first_name": "MITCHELL",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "314-638-8785",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "501422901",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• South County Urological, Inc.
• South County Vascular Associates, LLC
• South County Women'S Health, P.C.
• South Side Counseling Inc
• South St Louis Medical Associates LLC
• South St. Louis Rehab Institute, Inc.
• South St. Louis Rehabilitation Institute, Inc.
• Isabelle Thala Reed South, PA
• Carmen J Southall-Wamhoff
• Southampton Community Healthcare Inc

• All providers in St Louis, MO
• Orthopaedic Surgery Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.