Organization
MEDICAL & SURGICAL SPECIALISTS OF ROLLA, INC.
Active
Other names
Bond Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD KRENNING (CHIEF OPERATING OFFICER)
(573) 364-8822
Entity
Organization
Contact information
Practice address
600 BLUES LAKE PKWY, ROLLA, MO 65401-8022
(573) 364-8822
(573) 341-5969
Mailing address
600 BLUES LAKE PKWY, ROLLA, MO 65401-8022
(573) 364-8822
(573) 341-5969
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
207RH0003X
Hematology & Oncology Physician
—
—
207Y00000X
Otolaryngology Physician
—
—
207YX0602X
Otolaryngic Allergy Physician
—
—
208600000X
Surgery Physician
—
—
213E00000X
Podiatrist
—
—
363AS0400X
Surgical Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
503052706
—
MO
01
—
DA5531
RAIL ROAD MEDICARE
GA
Enumeration date
07/16/2006
Last updated
07/03/2008
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