Healthcare Provider Details

I. General information

NPI: 1396821336
Provider Name (Legal Business Name): TURNBAUGH SURGICAL ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 12/26/2019
Certification Date: 12/26/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1616 SOUTHRIDGE DR STE 202
JEFFERSON CITY MO
65109-5677
US

IV. Provider business mailing address

1616 SOUTHRIDGE DR STE 202
JEFFERSON CITY MO
65109-5677
US

V. Phone/Fax

Practice location:
  • Phone: 573-636-5450
  • Fax: 573-636-7906
Mailing address:
  • Phone: 573-636-5450
  • Fax: 573-636-7906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberR9C84
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. JEANNE SCHWALLER
Title or Position: ADMINISTRATOR
Credential: PH.D.
Phone: 573-230-3631