Healthcare Provider Details

I. General information

NPI: 1235408170
Provider Name (Legal Business Name): ROCKHILL ORTHOPAEDIC SPECIALISTS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2011
Last Update Date: 11/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 NE SAINT LUKES BLVD SUITE 200
LEES SUMMIT MO
64086-6000
US

IV. Provider business mailing address

120 NE SAINT LUKES BLVD STE 200
LEES SUMMIT MO
64086-6011
US

V. Phone/Fax

Practice location:
  • Phone: 816-502-8782
  • Fax: 816-246-8910
Mailing address:
  • Phone: 816-246-4302
  • Fax: 816-246-8910

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 Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. MATTHEW L MARINO
Title or Position: CFO
Credential:
Phone: 816-347-4782