Organization
SOUTHWEST MISSOURI BONE & JOINT, INC.
Active
Organization
SOUTHWEST MISSOURI BONE & JOINT, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN K ELLEFSEN D.O. (PRESIDENT)
(417) 358-0250
Entity
Organization
Contact information
Practice address
1911 BUENA VISTA AVE, CARTHAGE, MO 64836-3178
(417) 358-0250
(415) 358-3207
Mailing address
1911 BUENA VISTA AVE, CARTHAGE, MO 64836-3178
(417) 358-0250
(415) 358-3207
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
DO R5N34
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DE0991
RR MEDICARE
MO
Enumeration date
09/25/2006
Last updated
03/25/2008
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