Organization
SPINE AND ORTHOPAEDICS, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILLIAM O SAMUELSON M.D. (PRESIDENT)
(712) 224-8677
Entity
Organization
Contact information
Practice address
2800 PIERCE ST, SUITE 101, SIOUX CITY, IA 51104-3755
(712) 224-8677
(712) 277-1662
Mailing address
2800 PIERCE ST, SUITE 101, SIOUX CITY, IA 51104-3755
(712) 224-8677
(712) 277-1662
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
26070
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200017711
MEDICARE RR
IA
05
—
2044800
—
IA
Enumeration date
02/09/2007
Last updated
11/13/2009
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