Provider Demographics
NPI:1386726461
Name:MID MISSOURI HAND & ORTHOPEDIC SURGERY INC
Entity type:Organization
Organization Name:MID MISSOURI HAND & ORTHOPEDIC SURGERY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:W
Authorized Official - Last Name:CAMERON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:573-632-4263
Mailing Address - Street 1:1433 SOUTHWEST BLVD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65109-2429
Mailing Address - Country:US
Mailing Address - Phone:573-632-4263
Mailing Address - Fax:573-632-6529
Practice Address - Street 1:1433 SOUTHWEST BLVD
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-2429
Practice Address - Country:US
Practice Address - Phone:573-632-4263
Practice Address - Fax:573-632-6529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR8786207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200032999OtherRAILROAD MEDICARE
MO241975715Medicaid
MO000015489Medicare PIN
MO1247410001Medicare NSC
MO200032999OtherRAILROAD MEDICARE