Healthcare Provider Details

I. General information

NPI: 1730518150
Provider Name (Legal Business Name): SOUTHERN IOWA ORTHOPEDICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2013
Last Update Date: 02/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 S EAST ST
CORYDON IA
50060-1860
US

IV. Provider business mailing address

509 E MONROE ST
CORYDON IA
50060-1617
US

V. Phone/Fax

Practice location:
  • Phone: 641-872-2260
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: KEITH A HELSETH
Title or Position: MANAGER
Credential:
Phone: 641-872-2814