1235227885 NPI number — ORTHOPEDIC & SPORTS MEDICINE CENTER LLC

Table of content: (NPI 1235227885)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235227885 NPI number — ORTHOPEDIC & SPORTS MEDICINE CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ORTHOPEDIC & SPORTS MEDICINE CENTER LLC
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:
1235227885
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/20/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3107 FREDERICK AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT JOSEPH
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64506-2911
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-233-9888
Provider Business Mailing Address Fax Number:
816-233-0414

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
820 RAVENHILL DR
Provider Second Line Business Practice Location Address:
ATCHISON COMMUNITY HOSPITAL
Provider Business Practice Location Address City Name:
ATCHISON
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66002-9268
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-233-9888
Provider Business Practice Location Address Fax Number:
816-233-0414
Provider Enumeration Date:
10/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KEARNES
Authorized Official First Name:
SIOUX
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
816-233-9888

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  04-29855 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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