MEDICARE: MIDWEST ORTHOPEDIC SPECIALISTS INC

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	111NX0800X	Orthopedic Chiropractor

General Provider Information

NPI Number	:	1740667849
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDWEST ORTHOPEDIC SPECIALISTS INC

Provider Business Mailing Address
First Line	:	3740 E LAKE CTR
Second Line	:
City	:	QUINCY
State	:	IL
Zip	:	62305-5805
Country	:	US
Telephone Number	:	217-228-9422
Fax Number	:

Provider Business Practice Location Address
First Line	:	3740 E LAKE CTR
Second Line	:
City	:	QUINCY
State	:	IL
Zip	:	62305-5805
Country	:	US
Telephone Number	:	217-228-9422
Fax Number	:

Authorized Official
Title or Position	:	MANAGER PATIENT ACCOUNTS
Name	:	AMY L HADEN
Credential	:
Telephone Number	:	573-248-1010

Provider Enumeration Date	:	04/28/2015
Last Update Date	:	06/15/2015

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