Provider Demographics
NPI:1679529085
Name:KOPISKE ORTHOPEDIC SERVICES
Entity Type:Organization
Organization Name:KOPISKE ORTHOPEDIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:KOPISKE
Authorized Official - Suffix:
Authorized Official - Credentials:CO
Authorized Official - Phone:573-302-4733
Mailing Address - Street 1:1191 HIGHWAY KK
Mailing Address - Street 2:SUITE 101
Mailing Address - City:OSAGE BEACH
Mailing Address - State:MO
Mailing Address - Zip Code:65065-3344
Mailing Address - Country:US
Mailing Address - Phone:573-302-4733
Mailing Address - Fax:573-302-4735
Practice Address - Street 1:1191 HIGHWAY KK
Practice Address - Street 2:SUITE 101
Practice Address - City:OSAGE BEACH
Practice Address - State:MO
Practice Address - Zip Code:65065-3344
Practice Address - Country:US
Practice Address - Phone:573-302-4733
Practice Address - Fax:573-302-4735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO5146800001Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER