1356599641 NPI number — NEOSHO BONE & JOINT CLINIC P.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356599641 NPI number — NEOSHO BONE & JOINT CLINIC P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEOSHO BONE & JOINT CLINIC P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356599641
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4040 LAQUESTA DR.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEOSHO
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64850
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
417-451-1833
Provider Business Mailing Address Fax Number:
417-451-1825

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4040 LAQUESTA DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEOSHO
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64850
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-451-1833
Provider Business Practice Location Address Fax Number:
417-451-1825
Provider Enumeration Date:
08/29/2008

Additional Information

Authorized Official

Authorized Official Last Name:
PETERSEN
Authorized Official First Name:
HORACE
Authorized Official Middle Name:
REX
Authorized Official Title or Position:
ORTHOPEDIC SURGEON
Authorized Official Telephone Number:
417-451-1833

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  R9N57 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 246862114 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2026 www.npivalidator.com