Organization
MIDWEST ORTHOPEDIC SERVICES, SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACLYN M SCOTT (PRACTICE MANAGER)
(309) 341-1301
Entity
Organization
Contact information
Practice address
834 N SEMINARY ST, SUITE 406, GALESBURG, IL 61401-2852
(309) 341-1301
(309) 341-1377
Mailing address
834 N SEMINARY ST, SUITE 406, GALESBURG, IL 61401-2852
(309) 341-1301
(309) 341-1377
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
036-049846
IL
207X00000X
Orthopaedic Surgery Physician
036-052254
IL
213ES0131X
Foot Surgery Podiatrist
016-004267
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5725610001
MEDICARE DMEPOS# / ADMINSTAR FEDERAL
IL
Enumeration date
03/30/2009
Last updated
03/30/2009
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