Organization
MID-MO O&P LLC
Active
Parent organization
MID-MO O&P LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
MID-MO O&P LLC
Authorized official
BRIDGET RENEE MAHONEY (SR VP OPERATIONS)
(573) 441-0742
Entity
Organization
Contact information
Practice address
3559 AMAZONAS DR, JEFFERSON CITY, MO 65109-5717
(573) 636-9611
(573) 636-9632
Mailing address
1101 LAKEVIEW AVE, COLUMBIA, MO 65201-4659
(573) 441-0742
(573) 441-0745
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
08/06/2026
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