Organization Name: | SOUTHEAST IOWA ORTHOPEDICS & SPORTS MEDICINE PC |
NPI Number: | 1356521504 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MICHAEL W HENDRICKS (CEO) |
Mailing Address: | 600 N Main St Burlington |
State: | IA US |
Postal Code: | 526015012 |
Phone Number: | 3197589133 |
Fax Number: | 3197589143 |
NPI Enumeration Date: | 11/05/2007 |
NPI Last Update Date: | 11/06/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | 26178 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IA |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |