Provider Demographics
NPI:1578289328
Name:MID-MO O&P LLC
Entity Type:Organization
Organization Name:MID-MO O&P LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR VICE PRESIDENT OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:BRIDGET
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:DALY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-289-7760
Mailing Address - Street 1:1811 MARTIN SPRINGS DR STE D
Mailing Address - Street 2:
Mailing Address - City:ROLLA
Mailing Address - State:MO
Mailing Address - Zip Code:65401-2954
Mailing Address - Country:US
Mailing Address - Phone:573-364-8480
Mailing Address - Fax:573-364-8409
Practice Address - Street 1:1811 MARTIN SPRINGS DR STE D
Practice Address - Street 2:
Practice Address - City:ROLLA
Practice Address - State:MO
Practice Address - Zip Code:65401-2954
Practice Address - Country:US
Practice Address - Phone:573-364-8480
Practice Address - Fax:573-364-8409
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MID-MO O&P LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-10-13
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier