Healthcare Provider Details

I. General information

NPI: 1093780645
Provider Name (Legal Business Name): ORTHOPEDIC & SPORTS MEDICINE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 07/03/2024
Certification Date: 07/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3107 FREDERICK AVE SUITE B
SAINT JOSEPH MO
64506-2911
US

IV. Provider business mailing address

3107 FREDERICK AVE SUITE B
SAINT JOSEPH MO
64506-2911
US

V. Phone/Fax

Practice location:
  • Phone: 816-233-9888
  • Fax: 816-233-0414
Mailing address:
  • Phone: 816-233-9888
  • Fax: 816-233-0414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SIOUX KEARNES
Title or Position: OFFICE MANAGER
Credential:
Phone: 816-233-9888