Healthcare Provider Details

I. General information

NPI: 1861463473
Provider Name (Legal Business Name): ORTHOPAEDICS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2006
Last Update Date: 06/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 WEST 6TH ST SUITE 1
SPENCER IA
51301
US

IV. Provider business mailing address

20 WEST 6TH ST SUITE 1
SPENCER IA
51301
US

V. Phone/Fax

Practice location:
  • Phone: 712-580-2022
  • Fax: 712-580-2024
Mailing address:
  • Phone: 712-580-2022
  • Fax: 712-580-2024

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 Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number5151790001
License Number StateIA

VIII. Authorized Official

Name: DR. ALEXANDER PRUITT
Title or Position: PRESIDENT
Credential: MD
Phone: 712-580-2022