Healthcare Provider Details

I. General information

NPI: 1073314894
Provider Name (Legal Business Name): ORTHOPEDIC SURGICAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2025
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1706 PROSPECT DR
MACON MO
63552-2615
US

IV. Provider business mailing address

1706 PROSPECT DR
MACON MO
63552-2615
US

V. Phone/Fax

Practice location:
  • Phone: 660-385-1006
  • Fax: 660-385-1028
Mailing address:
  • Phone: 660-385-1006
  • Fax: 660-385-1028

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: DONET CHRISTOPHER MAIN
Title or Position: MEMBER
Credential: DO
Phone: 660-385-1006