Provider Demographics
NPI:1861677148
Name:ORTHOPEDIC OUTFITTERS OF EASTERN JACKSON COUNTY
Entity Type:Organization
Organization Name:ORTHOPEDIC OUTFITTERS OF EASTERN JACKSON COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:DUSENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-303-2498
Mailing Address - Street 1:19550 EAST 39TH STREET
Mailing Address - Street 2:SUITE 115
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64057
Mailing Address - Country:US
Mailing Address - Phone:816-303-2498
Mailing Address - Fax:816-303-2495
Practice Address - Street 1:19550 E 39TH ST S
Practice Address - Street 2:SUITE 115
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64057-2303
Practice Address - Country:US
Practice Address - Phone:816-303-2498
Practice Address - Fax:816-303-2495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-04
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies