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General NPI Number Information
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NPI Number | 1013906635
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Entity Type | Organization
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Legal Business Name | ST JOSEPH ORTHOPEDIC ASSOCIATES INC
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Dates
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Enumeration Date | 10/17/2005
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1335 VILLAGE DR
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City | SAINT JOSEPH
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State | MO
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Zip | 64506-2457
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Country | US
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Telephone | 800-875-0211
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Fax | 816-233-7258
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Provider Business Mailing Address
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Address Line | 1335 VILLAGE DR
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City | SAINT JOSEPH
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State | MO
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Zip | 64506-2457
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Country | US
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Telephone | 800-875-0211
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Fax | 816-233-7258
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Authorized Official
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Title or Position | OWNER
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Name | WILLIAM H GONDRING
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Credential | MD
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Telephone | 800-875-0211
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State | MO
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