Healthcare Provider Details

I. General information

NPI: 1215388293
Provider Name (Legal Business Name): WESTERN MISSOURI MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2016
Last Update Date: 11/01/2021
Certification Date: 11/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 S MAIN ST
CONCORDIA MO
64020
US

IV. Provider business mailing address

905 S MAIN ST
CONCORDIA MO
64020-8335
US

V. Phone/Fax

Practice location:
  • Phone: 660-463-7966
  • Fax: 660-463-7729
Mailing address:
  • Phone: 660-463-7966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL DEAN OHMART
Title or Position: CFO
Credential:
Phone: 660-262-7307