Healthcare Provider Details

I. General information

NPI: 1548324643
Provider Name (Legal Business Name): WESTERN MISSOURI RADIOLOGICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 07/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19609 E 9TH ST S
INDEPENDENCE MO
64056-3088
US

IV. Provider business mailing address

19609 E 9TH ST S
INDEPENDENCE MO
64056-3088
US

V. Phone/Fax

Practice location:
  • Phone: 816-796-1412
  • Fax:
Mailing address:
  • Phone: 816-796-1412
  • Fax: 816-796-3398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DEBRA WILSON
Title or Position: PRACTICE MANAGER
Credential:
Phone: 816-796-1412