Provider Demographics
NPI:1003271768
Name:MID-MO O&P LLC
Entity Type:Organization
Organization Name:MID-MO O&P LLC
Other - Org Name:MID MISSOURI ORTHOTICS & PROSTHETICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:573-441-0742
Mailing Address - Street 1:1101 LAKEVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-4659
Mailing Address - Country:US
Mailing Address - Phone:573-441-0742
Mailing Address - Fax:573-441-0745
Practice Address - Street 1:1811 MARTIN SPRINGS DR
Practice Address - Street 2:SUITE C
Practice Address - City:ROLLA
Practice Address - State:MO
Practice Address - Zip Code:65401-2954
Practice Address - Country:US
Practice Address - Phone:573-364-8480
Practice Address - Fax:573-364-8409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-23
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies