Healthcare Provider Details

I. General information

NPI: 1396879961
Provider Name (Legal Business Name): CURATORS UNIVERSITY OF MO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 01/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N MAIN ST
MOUNT VERNON MO
65712-1004
US

IV. Provider business mailing address

600 N MAIN ST
MOUNT VERNON MO
65712-1004
US

V. Phone/Fax

Practice location:
  • Phone: 417-461-5312
  • Fax: 417-461-5765
Mailing address:
  • Phone: 417-461-5312
  • Fax: 417-461-5765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: MITCHELL L WASDEN
Title or Position: CEO/COO
Credential:
Phone: 573-884-8738