MID-MISSOURI ORTHOTICS & PROSTHETICS (NPI# 1740265495) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1740265495 |
| Entity Type | Organization |
| Organization Name | MID-MISSOURI ORTHOTICS & PROSTHETICS |
| Practice Address |
3559 Amazonas Dr Jefferson City MO 65109-5717 |
| Practice Telephone | 5736369611 |
| Practice Fax Number | 5736369632 |
| Mailing Telephone | 5736369611 |
| Mailing Fax Number | 5736369632 |
| Enumeration Date | 2005-12-14 |
| Last Update Date | 2012-01-19 |
| Authorized Official Name | MR. TRACY D ELL (CEO/OWNER) |
| Authorized Official Telephone | 5736369611 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 335E00000X | Prosthetic/Orthotic Supplier | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | HEALTHLINK | 522024 | 01 |
| MO | BLUE CROSS/BLUE SHIELD | 166056 | 01 |
| MO | HEALTHCARE USA | 41486 | 01 |
| MO | 627800907 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770566499 | Mid-missouri Orthotics & Prosthetics | Prosthetic/Orthotic Supplier | 1101 Lakeview Ave, Columbia, MO 65201-4659 | 2005-11-28 |
| Street Address |
3559 AMAZONAS DR |
| City | JEFFERSON CITY |
| State | MO |
| Zip Code | 65109-5717 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518449321 | Kara D Roderick | Physical Therapist | 1115 Fairgrounds Road, Jefferson City, MO 65109 | 2018-08-29 |
| 1851871214 | Integrative Medicine, LLC | Internal Medicine | 999 Diamond Rdg Ste 201, Jefferson City, MO 65109 | 2018-08-15 |
| 1972020394 | Rehab Care Group East, LLC | Clinic/Center | Primrose Retirement Community Jefferson City, 1214 Freedom Boulevard, Jefferson City, MO 65109 | 2017-08-25 |
| 1124558986 | Nicholas Rehagen | Specialist/Technologist | 304 Timber Creek Rd, Jefferson City, MO 65109 | 2017-06-14 |
| 1982004214 | Kara Elizabeth Wilbers | Occupational Therapist | 1105 Fairgrounds Rd, Jefferson City, MO 65109 | 2014-08-22 |
| 1942510334 | Loftin Eyecare, LLC | Optometrist | 724 West Stadium Boulevard, # 029 Walmart Vision Center, Jefferson City, MO 65109 | 2010-10-19 |
| 1306077250 | Paula Hancock Johnson | Social Worker | 1303 Edgewood Dr Ste 5, Jefferson City, MO 65109 | 2009-07-27 |
| 1679701296 | Capital Region Medical Center | Family Medicine | 3308 W Edgewood, Suite B, Jefferson City, MO 65109 | 2009-06-23 |
| 1972730141 | Nancy S Stork | Counselor | 204 Metro, Suite B, Jefferson City, MO 65109 | 2009-06-16 |
| 1356522916 | Walk Easy LLC | Durable Medical Equipment & Medical Supplies | 4810 Rainbow Dr., Jefferson City, MO 65109 | 2007-11-23 |
| Find all providers in zip 65109 | ||||
| Taxonomy Code | 335E00000X |
| Grouping | Suppliers |
| Classification | Prosthetic/Orthotic Supplier |
| An organization that provides prosthetic and orthotic care which may include, but is not limited to, patient evaluation, prosthesis or orthosis design, fabrication, fitting and modification to treat limb loss for purposes of restoring physiological function and/or cosmesis or to treat a neuromusculoskeletal disorder or acquired condition. |
| Notes: Source: American Board for Certification in Orthotics, Prosthetics, and Pedorthics, Inc. [7/1/2010: modified, 7/1/2013: modified] Additional Resources: American Board for Certification in Orthotics, Prosthetics and Pedorthics, Inc., www.abcop.org and Board of Certification/Accreditation, International, www.bocusa.org. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255685970 | Mid America Prosthetic Center, LLC. | Prosthetic/Orthotic Supplier | 1001 Southwest Blvd, Suite E, Jefferson City, MO 65109-2501 | 2012-11-02 |
| 1366622771 | Columbia O & P Labs | Prosthetic/Orthotic Supplier | 1735 Southwest Blvd, Jefferson City, MO 65109-2435 | 2007-11-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497355689 | Hair On The Edge | Prosthetic/Orthotic Supplier | 9708 Lackland Rd, Overland, MO 63114-3414 | 2020-10-28 |
| 1427656727 | Cranial Technologies, Inc. | Prosthetic/Orthotic Supplier | 755 S New Ballas Rd Ste 140, Saint Louis, MO 63141-8713 | 2020-10-09 |
| 1437783776 | Mager & Gougelman of St. Louis, LLC | Prosthetic/Orthotic Supplier | 1034 S Brentwood Blvd Ste 1880, Richmond Heights, MO 63117-1218 | 2020-02-25 |
| 1962042440 | Fourroux Prosthetics, Inc | Prosthetic/Orthotic Supplier | 9665 Page Avenue, Overland, MO 63132 | 2020-01-13 |
| 1407496201 | Ortheco LLC | Prosthetic/Orthotic Supplier | 2907 Independence St Ste D, Cape Girardeau, MO 63703-5027 | 2020-01-09 |
| 1477100717 | Desirae Clark | Prosthetic/Orthotic Supplier | 5100 Lydia Ave, Kansas City, MO 64110-2608 | 2019-08-21 |
| 1720540313 | Axes Physical Therapy, LLC | Prosthetic/Orthotic Supplier | 754 Luetkenhaus Blvd, Wentzville, MO 63385-3515 | 2019-04-02 |
| 1093272460 | Axes Physical Therapy I, LLC | Prosthetic/Orthotic Supplier | 2018 Phoenix Center Dr, Washington, MO 63090-5544 | 2019-02-21 |
| 1215400312 | Cranial Technologies, Inc. | Prosthetic/Orthotic Supplier | 4801 Main St Ste 220, Kansas City, MO 64112-2929 | 2019-01-10 |
| 1649778382 | Boston Brace International Inc. | Prosthetic/Orthotic Supplier | 50 Crestwood Executive Ctr Ste 315, Saint Louis, MO 63126-1900 | 2018-01-29 |
| Find all providers with the same taxonomy | ||||
| City | JEFFERSON CITY |
| Zip Code | 65109 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.