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General NPI Number Information
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NPI Number | 1588617278
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Entity Type | Organization
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Legal Business Name | MIDWEST ORTHOPAEDIC SURGERY INC
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Dates
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Enumeration Date | 05/17/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3105 MCCLELLAND BLVD
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City | JOPLIN
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State | MO
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Zip | 64804-1640
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Country | US
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Telephone | 417-781-2807
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2507
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City | JOPLIN
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State | MO
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Zip | 64803-2507
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Country | US
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Telephone | 417-781-2807
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. MARLENE M REINEKE
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Credential |
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Telephone | 417-781-2807
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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 |
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