Provider Demographics
NPI:1215028998
Name:HUBBARD BONE & JOINT CLINIC LLC
Entity Type:Organization
Organization Name:HUBBARD BONE & JOINT CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE COORDINATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:GASTINEAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-255-2063
Mailing Address - Street 1:805 N KENTUCKY ST
Mailing Address - Street 2:
Mailing Address - City:WEST PLAINS
Mailing Address - State:MO
Mailing Address - Zip Code:65775-2022
Mailing Address - Country:US
Mailing Address - Phone:417-255-2063
Mailing Address - Fax:417-255-2062
Practice Address - Street 1:805 N KENTUCKY ST
Practice Address - Street 2:
Practice Address - City:WEST PLAINS
Practice Address - State:MO
Practice Address - Zip Code:65775-2022
Practice Address - Country:US
Practice Address - Phone:417-255-2063
Practice Address - Fax:417-255-2062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO119275174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000014046OtherMEDICARE RR
MO244647806Medicaid
000014046OtherMEDICARE RR
MO244647806Medicaid
MO5447020001Medicare NSC