Provider Demographics
NPI:1275677023
Name:PUTNAM ORTHOPAEDIC CENTER, LLC
Entity Type:Organization
Organization Name:PUTNAM ORTHOPAEDIC CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:LESLIE
Authorized Official - Last Name:PUTNAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:417-447-1000
Mailing Address - Street 1:4350 S NATIONAL AVE
Mailing Address - Street 2:SUITE C200
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65810-2607
Mailing Address - Country:US
Mailing Address - Phone:417-447-1000
Mailing Address - Fax:417-447-6150
Practice Address - Street 1:4350 S NATIONAL AVE
Practice Address - Street 2:SUITE C200
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65810-2607
Practice Address - Country:US
Practice Address - Phone:417-447-1000
Practice Address - Fax:417-447-6150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic SurgeryGroup - Single Specialty