Provider Demographics
NPI:1013906635
Name:ST JOSEPH ORTHOPEDIC ASSOCIATES INC
Entity Type:Organization
Organization Name:ST JOSEPH ORTHOPEDIC ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:H
Authorized Official - Last Name:GONDRING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:800-875-0211
Mailing Address - Street 1:1335 VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-2457
Mailing Address - Country:US
Mailing Address - Phone:800-875-0211
Mailing Address - Fax:816-233-7258
Practice Address - Street 1:1335 VILLAGE DR
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-2457
Practice Address - Country:US
Practice Address - Phone:800-875-0211
Practice Address - Fax:816-233-7258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO04974023OtherBCBS KC PIN
KS074632OtherBCBS KS PIN
KS074632OtherBCBS KS PIN