Provider Demographics
NPI:1437297967
Name:MIDWEST BONE & JOINT CENTER, PC
Entity type:Organization
Organization Name:MIDWEST BONE & JOINT CENTER, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONET
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:MAIN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:660-385-1006
Mailing Address - Street 1:PO BOX 795057
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63179-0795
Mailing Address - Country:US
Mailing Address - Phone:314-989-0300
Mailing Address - Fax:
Practice Address - Street 1:1517 UNION AVE
Practice Address - Street 2:SUITE D
Practice Address - City:MOBERLY
Practice Address - State:MO
Practice Address - Zip Code:65270-9471
Practice Address - Country:US
Practice Address - Phone:660-385-1006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
MO110583207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty