| Bluetail Medical Group, Llc. | |
|
17300 N Outer 40 Rd Suite 201 Chesterfield MO 63005-1375 | |
| (636) 778-2900 | |
| (636) 778-2828 |
| Full Name | Bluetail Medical Group, Llc. |
|---|---|
| Speciality | Orthopaedic Surgery |
| Location | 17300 N Outer 40 Rd, Chesterfield, Missouri |
| Authorized Official Name and Position | Matthew Bayes (AUTHORIZED OFFICIAL) |
| Authorized Official Contact | 6367782900 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bluetail Medical Group, Llc. Po Box 11665 Belfast ME 04915-4007 Ph: (636) 778-2900 | Bluetail Medical Group, Llc. 17300 N Outer 40 Rd Suite 201 Chesterfield MO 63005-1375 Ph: (636) 778-2900 |
| NPI Number | 1285986398 |
|---|---|
| Provider Enumeration Date | 10/12/2012 |
| Last Update Date | 09/22/2023 |
| Medicare PECOS PAC ID | 1456599141 |
|---|---|
| Medicare Enrollment ID | O20130828000660 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285986398 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
| 207XX0005X | Orthopaedic Surgery - Sports Medicine | LC1262307 (Missouri) | Primary |
| Provider Name | David M Crane |
|---|---|
| Provider Type | Practitioner - Sports Medicine |
| Provider Identifiers | NPI Number: 1144291089 PECOS PAC ID: 0446280366 Enrollment ID: I20050819000270 |
| Provider Name | Christopher J Wolf |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1942240833 PECOS PAC ID: 6002918851 Enrollment ID: I20070226000024 |
| Provider Name | Matthew C Bayes |
|---|---|
| Provider Type | Practitioner - Sports Medicine |
| Provider Identifiers | NPI Number: 1396728002 PECOS PAC ID: 3173699816 Enrollment ID: I20080904000297 |
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