Organization
MID-MISSOURI ORTHOTICS & PROSTHETICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TRACY D ELL (CEO/OWNER)
(573) 636-9611
Entity
Organization
Contact information
Practice address
3559 AMAZONAS DR, JEFFERSON CITY, MO 65109-5717
(573) 636-9611
(573) 636-9632
Mailing address
3559 AMAZONAS DR, JEFFERSON CITY, MO 65109-5717
(573) 636-9611
(573) 636-9632
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
166056
BLUE CROSS/BLUE SHIELD
MO
01
—
41486
HEALTHCARE USA
MO
01
—
522024
HEALTHLINK
MO
05
—
627800907
—
MO
Enumeration date
12/14/2005
Last updated
01/19/2012
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