Healthcare Provider Details

I. General information

NPI: 1902812407
Provider Name (Legal Business Name): MIDWEST BONE & JOINT CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 12/01/2022
Certification Date: 12/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1706 PROSPECT DR
MACON MO
63552-2615
US

IV. Provider business mailing address

PO BOX 402
MACON MO
63552-0402
US

V. Phone/Fax

Practice location:
  • Phone: 660-385-1006
  • Fax: 660-385-1028
Mailing address:
  • Phone: 660-385-1008
  • Fax: 660-385-1062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

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