Provider Demographics
NPI:1356863567
Name:MIDWEST ORTHOPEDIC SPECIALISTS INC
Entity type:Organization
Organization Name:MIDWEST ORTHOPEDIC SPECIALISTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:W-2 EMPLOYEE
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:L
Authorized Official - Last Name:HADEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-248-1010
Mailing Address - Street 1:188 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:HANNIBAL
Mailing Address - State:MO
Mailing Address - Zip Code:63401-6877
Mailing Address - Country:US
Mailing Address - Phone:573-248-1010
Mailing Address - Fax:
Practice Address - Street 1:927 BROADWAY ST STE 130
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-2715
Practice Address - Country:US
Practice Address - Phone:217-228-9422
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-10
Last Update Date:2017-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty