MEDICARE: WEDGEWOOD INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility	032731	MO

General Provider Information

NPI Number	:	1437287661
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEDGEWOOD INC

Provider Business Mailing Address
First Line	:	17996 STATE HIGHWAY 13
Second Line	:
City	:	REEDS SPRING
State	:	MO
Zip	:	65737-9663
Country	:	US
Telephone Number	:	417-272-6666
Fax Number	:	417-272-1822

Provider Business Practice Location Address
First Line	:	17996 STATE HIGHWAY 13
Second Line	:
City	:	REEDS SPRING
State	:	MO
Zip	:	65737-9663
Country	:	US
Telephone Number	:	417-272-6666
Fax Number	:	417-272-1822

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	WILLIAM KENNY
Credential	:
Telephone Number	:	417-272-6666

Provider Enumeration Date	:	03/01/2007
Last Update Date	:	08/22/2020

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Directions to “WEDGEWOOD INC ” Practice Location

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