=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699893065
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MID-AMERICA ORTHOPEDIC INSTITUTE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/26/2007
-----------------------------------------------------
Last Update Date | 07/16/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1905 S HIGH ST
-----------------------------------------------------
City | KIRKSVILLE
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63501-4764
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 660-665-7008
-----------------------------------------------------
Fax | 660-665-0331
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1905 S HIGH ST
-----------------------------------------------------
City | KIRKSVILLE
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63501-4764
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 660-665-7008
-----------------------------------------------------
Fax | 660-665-0331
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ORTHOPEDIC SURGEON
-----------------------------------------------------
Name | DR. KEVIN ANDREW KLINE
-----------------------------------------------------
Credential | D.O.
-----------------------------------------------------
Telephone | 660-665-7008
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | R5P98
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------