Provider Demographics
NPI:1902812407
Name:MIDWEST BONE & JOINT CENTER PC
Entity type:Organization
Organization Name:MIDWEST BONE & JOINT CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONET
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:MAIN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:660-385-1006
Mailing Address - Street 1:PO BOX 402
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:MO
Mailing Address - Zip Code:63552-0402
Mailing Address - Country:US
Mailing Address - Phone:660-385-1008
Mailing Address - Fax:660-385-1062
Practice Address - Street 1:1706 PROSPECT DR
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:MO
Practice Address - Zip Code:63552-2615
Practice Address - Country:US
Practice Address - Phone:660-385-1006
Practice Address - Fax:660-385-1028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic SurgeryGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOCK3308OtherRR MEDICARE
MOCK3308OtherRR MEDICARE
MOG62668Medicare UPIN
MO000013670Medicare PIN