Healthcare Provider Details

I. General information

NPI: 1457095044
Provider Name (Legal Business Name): COLUMBIA MUSCULOSKELETAL SURGERY CNTR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2022
Last Update Date: 05/31/2022
Certification Date: 05/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 N KEENE ST STE 107
COLUMBIA MO
65201-6897
US

IV. Provider business mailing address

305 N KEENE ST STE 107
COLUMBIA MO
65201-6897
US

V. Phone/Fax

Practice location:
  • Phone: 972-763-3859
  • Fax:
Mailing address:
  • Phone: 573-256-0235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER HARTSHORN
Title or Position: OFFICER/AUTHORIZED OFFICIAL
Credential:
Phone: 314-800-2017