OrganizationActive
Iconic Services Inc
NPI 1750872354 · Sports Medicine (Family Medicine) Physician · Saint Louis, MO
Provider details
- NPI number
- 1750872354
- Entity type
- Organization
- Primary specialty
- Sports Medicine (Family Medicine) PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Christine Cordero, Manager(314) 437-8932
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Profile Score
Established profile(68/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
8 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
4625 Lindell Blvd Ste 200
Saint Louis, MO 63108-3729
Phone: (314) 437-8932
Fax: (888) 749-2228
Street-level locationGet directions
Mailing address
4625 Lindell Blvd Ste 200
Saint Louis, MO 63108-3729
Registry dates
- Enumerated
- 2018-05-21
- Last updated
- 2018-05-21
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.