Healthcare Provider Details

I. General information

NPI: 1003620329
Provider Name (Legal Business Name): CMC MULTISPECIALTY CARE COMO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2025
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 N KEENE ST STE 105A
COLUMBIA MO
65201-6897
US

IV. Provider business mailing address

8809 SE 1ST ST
LEES SUMMIT MO
64064-7858
US

V. Phone/Fax

Practice location:
  • Phone: 816-674-2693
  • Fax:
Mailing address:
  • Phone: 816-674-2693
  • Fax: 816-674-2693

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ASTON GOLDSOWRTHY
Title or Position: OWNER
Credential: DC, FNP-BC
Phone: 816-674-2693