Provider Demographics
NPI:1174628432
Name:CENTER OF ORTHOPEDIC EXCELLENCE INC
Entity Type:Organization
Organization Name:CENTER OF ORTHOPEDIC EXCELLENCE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:C
Authorized Official - Last Name:GALBRAITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-636-5285
Mailing Address - Street 1:3308 W EDGEWOOD DR
Mailing Address - Street 2:STE A
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65109-6891
Mailing Address - Country:US
Mailing Address - Phone:573-636-5285
Mailing Address - Fax:573-636-3725
Practice Address - Street 1:3308 W EDGEWOOD DR
Practice Address - Street 2:STE A
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-6891
Practice Address - Country:US
Practice Address - Phone:573-636-5285
Practice Address - Fax:573-636-3725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO501288500Medicaid
MO990001502Medicare ID - Type UnspecifiedMEDICARE GROUP