Provider Demographics
NPI:1740667849
Name:MIDWEST ORTHOPEDIC SPECIALISTS INC
Entity type:Organization
Organization Name:MIDWEST ORTHOPEDIC SPECIALISTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER PATIENT ACCOUNTS
Authorized Official - Prefix:
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 1:3740 E LAKE CTR
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62305-5805
Mailing Address - Country:US
Mailing Address - Phone:217-228-9422
Mailing Address - Fax:
Practice Address - Street 1:3740 E LAKE CTR
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62305-5805
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:2015-04-28
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL211981Medicare PIN