Basic Information
| Provider Information | |||||||||
| NPI: | 1003268087 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ADVANCED ORTHOPEDICS AND SPORTS MEDICINE | ||||||||
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| OtherOrganizationName: | SANO ORTHOPEDICS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2861 NE INDEPENDENCE AVE STE 201 | ||||||||
| Address2: | |||||||||
| City: | LEES SUMMIT | ||||||||
| State: | MO | ||||||||
| PostalCode: | 640642379 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8165252840 | ||||||||
| FaxNumber: | 8165252841 | ||||||||
| Practice Location | |||||||||
| Address1: | 2861 NE INDEPENDENCE AVE STE 201 | ||||||||
| Address2: | |||||||||
| City: | LEES SUMMIT | ||||||||
| State: | MO | ||||||||
| PostalCode: | 640642379 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8165252840 | ||||||||
| FaxNumber: | 8165252841 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2016 | ||||||||
| LastUpdateDate: | 12/16/2021 | ||||||||
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| AuthorizedOfficialLastName: | DAGGETT | ||||||||
| AuthorizedOfficialFirstName: | MATTHEW | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | VP OF OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 8165252840 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 12/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.