Provider Demographics
NPI:1740248087
Name:MID MISSOURI NEUROSURGERY, LLP
Entity type:Organization
Organization Name:MID MISSOURI NEUROSURGERY, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:P
Authorized Official - Last Name:BONDURANT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:573-443-2355
Mailing Address - Street 1:1605 E BROADWAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-8023
Mailing Address - Country:US
Mailing Address - Phone:573-443-2355
Mailing Address - Fax:573-874-3025
Practice Address - Street 1:1605 E BROADWAY
Practice Address - Street 2:SUITE 100
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-8023
Practice Address - Country:US
Practice Address - Phone:573-443-2355
Practice Address - Fax:573-874-3025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty