MEDICARE: HUBBARD BONE & JOINT CLINIC LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	119275	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000014046	OTHER		MEDICARE RR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215028998
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HUBBARD BONE & JOINT CLINIC LLC

Provider Business Mailing Address
First Line	:	805 N KENTUCKY ST
Second Line	:
City	:	WEST PLAINS
State	:	MO
Zip	:	65775-2022
Country	:	US
Telephone Number	:	417-255-2063
Fax Number	:	417-255-2062

Provider Business Practice Location Address
First Line	:	805 N KENTUCKY ST
Second Line	:
City	:	WEST PLAINS
State	:	MO
Zip	:	65775-2022
Country	:	US
Telephone Number	:	417-255-2063
Fax Number	:	417-255-2062

Authorized Official
Title or Position	:	OFFICE COORDINATOR
Name	:	MR. DAWN GASTINEAU
Credential	:
Telephone Number	:	417-255-2063

Provider Enumeration Date	:	09/27/2006
Last Update Date	:	08/03/2011

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Directions to “HUBBARD BONE & JOINT CLINIC LLC ” Practice Location

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