Healthcare Provider Details

I. General information

NPI: 1407275852
Provider Name (Legal Business Name): MID-MO O&P LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2014
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 TURNER BLVD
SAINT PETERS MO
63376-1079
US

IV. Provider business mailing address

1101 LAKEVIEW AVE
COLUMBIA MO
65201-4659
US

V. Phone/Fax

Practice location:
  • Phone: 573-441-0744
  • Fax: 573-441-0745
Mailing address:
  • Phone: 573-441-0744
  • Fax: 573-441-0745

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: BRIDGET RENEE MAHONEY
Title or Position: SR VP OPERATIONS
Credential:
Phone: 573-441-0742