Provider Demographics
NPI:1023487709
Name:MISSOURI VALLEY SPORTS MEDICINE AND ORTHOPEDICS INC
Entity type:Organization
Organization Name:MISSOURI VALLEY SPORTS MEDICINE AND ORTHOPEDICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLEFSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:660-826-5750
Mailing Address - Street 1:2100 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SEDALIA
Mailing Address - State:MO
Mailing Address - Zip Code:65301-2351
Mailing Address - Country:US
Mailing Address - Phone:660-826-5750
Mailing Address - Fax:660-829-0213
Practice Address - Street 1:2100 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SEDALIA
Practice Address - State:MO
Practice Address - Zip Code:65301-2351
Practice Address - Country:US
Practice Address - Phone:660-826-5750
Practice Address - Fax:660-829-0213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-23
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR5N34207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty