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General NPI Number Information
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NPI Number | 1255432399
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Entity Type | Organization
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Legal Business Name | SOUTHWEST MISSOURI BONE & JOINT, INC.
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Dates
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Enumeration Date | 09/25/2006
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Last Update Date | 03/25/2008
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Provider Practice Location Address
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Address Line | 1911 BUENA VISTA AVE
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City | CARTHAGE
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State | MO
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Zip | 64836-3178
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Country | US
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Telephone | 417-358-0250
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Fax | 415-358-3207
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Provider Business Mailing Address
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Address Line | 1911 BUENA VISTA AVE
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City | CARTHAGE
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State | MO
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Zip | 64836-3178
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Country | US
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Telephone | 417-358-0250
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Fax | 415-358-3207
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Authorized Official
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Title or Position | PRESIDENT
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Name | BRIAN K ELLEFSEN
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Credential | D.O.
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Telephone | 417-358-0250
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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 | DO R5N34
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License Number State | MO
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