Organization Name: | SPINE MIDWEST, INC |
NPI Number: | 1003096306 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | WILLIAM BLAKE RODGERS (PRESIDENT) |
Mailing Address: | 200 Saint Marys Medical Plz Suite 301 Jefferson City |
State: | MO US |
Postal Code: | 651011604 |
Phone Number: | 5736344212 |
Fax Number: | |
NPI Enumeration Date: | 11/05/2007 |
NPI Last Update Date: | 11/05/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QM1300X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Multi-Specialty |
Taxonomy Definition: |