Provider Demographics
NPI:1477639235
Name:ORTHOPAEDICS, PC
Entity Type:Organization
Organization Name:ORTHOPAEDICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:PRUITT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:712-580-2022
Mailing Address - Street 1:20 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:IA
Mailing Address - Zip Code:51301-3901
Mailing Address - Country:US
Mailing Address - Phone:712-580-2022
Mailing Address - Fax:712-580-2024
Practice Address - Street 1:20 W 6TH ST
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:IA
Practice Address - Zip Code:51301-3901
Practice Address - Country:US
Practice Address - Phone:712-580-2022
Practice Address - Fax:712-580-2024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA29040207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1861463473OtherCLINIC NPI
IA0481754Medicaid
IA1477639235OtherDMERC REGION D NPI
IAI11301Medicare ID - Type UnspecifiedIOWA MEDICARE