Provider Demographics
NPI:1861463473
Name:ORTHOPAEDICS PC
Entity Type:Organization
Organization Name:ORTHOPAEDICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
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 WEST 6TH ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SPENCER
Mailing Address - State:IA
Mailing Address - Zip Code:51301
Mailing Address - Country:US
Mailing Address - Phone:712-580-2022
Mailing Address - Fax:712-580-2024
Practice Address - Street 1:20 WEST 6TH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:SPENCER
Practice Address - State:IA
Practice Address - Zip Code:51301
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:2006-01-31
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207X00000X
IA5151790001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0481754Medicaid
IA71119OtherWELLMARK SELECT
IADE0140OtherRAILROAD MEDICARE
0180034OtherUS DEPT OF LABOR & INDUST
204803800OtherUS DEPT OF LABOR (ACS)
IA71119OtherBCBS OF IA
104435OtherHEALTH PARTNERS
104435OtherHEALTH PARTNERS
IA0481754Medicaid
IA0481754Medicaid
IA71119OtherWELLMARK SELECT