MEDICARE: KOPISKE ORTHOPEDIC SERVICES

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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1679529085
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KOPISKE ORTHOPEDIC SERVICES

Provider Business Mailing Address
First Line	:	1191 HIGHWAY KK
Second Line	:	SUITE 101
City	:	OSAGE BEACH
State	:	MO
Zip	:	65065-3344
Country	:	US
Telephone Number	:	573-302-4733
Fax Number	:	573-302-4735

Provider Business Practice Location Address
First Line	:	1191 HIGHWAY KK
Second Line	:	SUITE 101
City	:	OSAGE BEACH
State	:	MO
Zip	:	65065-3344
Country	:	US
Telephone Number	:	573-302-4733
Fax Number	:	573-302-4735

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. THOMAS KOPISKE
Credential	:	CO
Telephone Number	:	573-302-4733

Provider Enumeration Date	:	05/26/2006
Last Update Date	:	08/22/2020

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