Provider Demographics
NPI:1316019193
Name:ORTHOPAEDIC SPECIALISTS OF THE FOUR STATES LLC
Entity Type:Organization
Organization Name:ORTHOPAEDIC SPECIALISTS OF THE FOUR STATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF ADMINISTRATIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:M
Authorized Official - Last Name:CAPUTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-783-4441
Mailing Address - Street 1:PO BOX 2546
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64803-2546
Mailing Address - Country:US
Mailing Address - Phone:620-783-4441
Mailing Address - Fax:620-783-4444
Practice Address - Street 1:444 FOUR STATES DR
Practice Address - Street 2:SUITE 1
Practice Address - City:GALENA
Practice Address - State:KS
Practice Address - Zip Code:66739-4324
Practice Address - Country:US
Practice Address - Phone:620-783-4441
Practice Address - Fax:620-783-4185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO207X00000X, 207XS0117X
KS207X00000X, 332B00000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
No335E00000XSuppliersProsthetic/Orthotic SupplierGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSKA1177Medicare PIN
KS5826200001Medicare NSC