Provider Demographics
NPI:1831369107
Name:MIDAMERICA ORTHOPAEDIC AND SPINE INSTITUTE LLC
Entity type:Organization
Organization Name:MIDAMERICA ORTHOPAEDIC AND SPINE INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:660-665-0950
Mailing Address - Street 1:1701 N ELSON ST
Mailing Address - Street 2:
Mailing Address - City:KIRKSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63501-1129
Mailing Address - Country:US
Mailing Address - Phone:660-665-0950
Mailing Address - Fax:660-665-0699
Practice Address - Street 1:1701 N ELSON ST
Practice Address - Street 2:
Practice Address - City:KIRKSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63501-1129
Practice Address - Country:US
Practice Address - Phone:660-665-0950
Practice Address - Fax:660-665-0699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO110360261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO244728507Medicaid
MO000015733Medicare PIN
MOG44875Medicare UPIN