Provider Demographics
NPI:1588164347
Name:ORTHOPEDIC ASSOCIATES OF JC, LLC
Entity type:Organization
Organization Name:ORTHOPEDIC ASSOCIATES OF JC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:WESLEY
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:816-729-1913
Mailing Address - Street 1:3709 S BOLGER CT
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-3971
Mailing Address - Country:US
Mailing Address - Phone:816-729-1913
Mailing Address - Fax:855-862-9292
Practice Address - Street 1:19201 E VALLEY VIEW PKWY STE C
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-6913
Practice Address - Country:US
Practice Address - Phone:816-317-5070
Practice Address - Fax:855-862-9292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-19
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR3688207X00000X
207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty