Randall D Roush, MD | |
12266 Depaul Dr, 110, Bridgeton, MO 63044-2514 | |
(314) 291-7900 | |
(314) 291-7914 |
Full Name | Randall D Roush |
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Gender | Male |
Speciality | Orthopaedic Surgery |
Location | 12266 Depaul Dr, Bridgeton, Missouri |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1255357091 | NPI | - | NPPES |
207746603 | Medicaid | MO |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207X00000X | Orthopaedic Surgery | R9C72 (Missouri) | Primary |
Entity Name | Ssm Medical Group Inc |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1700966207 PECOS PAC ID: 6608776299 Enrollment ID: O20040729001034 |
Mailing Address | Practice Location Address |
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Randall D Roush, MD 1805 Summer Blossom Pl, Chesterfield, MO 63017-5672 Ph: () - | Randall D Roush, MD 12266 Depaul Dr, 110, Bridgeton, MO 63044-2514 Ph: (314) 291-7900 |
Crystel D Knierim, MD Orthopedic Surgery Medicare: Accepting Medicare Assignments Practice Location: 12349 De Paul Dr Ste 100, Bridgeton, MO 63044 Phone: 314-291-7900 | |
Terry J Weis, DO Orthopedic Surgery Medicare: Medicare Enrolled Practice Location: 12266 Depaul Dr, 110, Bridgeton, MO 63044 Phone: 314-291-7900 Fax: 314-291-7914 | |
Fallon H Maylack, MD Orthopedic Surgery Medicare: Accepting Medicare Assignments Practice Location: 12255 De Paul Dr, Ste 845, Bridgeton, MO 63044 Phone: 314-884-6320 Fax: 314-884-6321 | |
Dr. Ramin Matthew Lalezari, MD Orthopedic Surgery Medicare: Medicare Enrolled Practice Location: 12303 De Paul Dr, Bridgeton, MO 63044 Phone: 314-344-6000 | |
Katherine A Burns, M.D. Orthopedic Surgery Medicare: Accepting Medicare Assignments Practice Location: 12349 De Paul Dr Ste 100, Bridgeton, MO 63044 Phone: 314-291-7900 | |
William C Schroer, M.D. Orthopedic Surgery Medicare: Accepting Medicare Assignments Practice Location: 12349 De Paul Dr Ste 100, Bridgeton, MO 63044 Phone: 314-291-7900 |