Healthcare Provider Details

I. General information

NPI: 1902989072
Provider Name (Legal Business Name): ORTHOPAEDIC ASSOCIATES OF SOUTHEAST MISSOURI, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 05/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 DOCTORS PARK
CAPE GIRARDEAU MO
63703-4928
US

IV. Provider business mailing address

48 DOCTORS PARK
CAPE GIRARDEAU MO
63703-4928
US

V. Phone/Fax

Practice location:
  • Phone: 573-335-8257
  • Fax: 573-335-8424
Mailing address:
  • Phone: 573-335-8257
  • Fax: 573-335-8424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. TOM J WEBER
Title or Position: ADMINISTRATOR
Credential:
Phone: 573-335-8257