Healthcare Provider Details

I. General information

NPI: 1003872185
Provider Name (Legal Business Name): MIDWEST DIVISION - LRHC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 01/06/2022
Certification Date: 01/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 WEST 40 HWY
ODESSA MO
64076-9612
US

IV. Provider business mailing address

316 WEST 40 HWY
ODESSA MO
64076-9612
US

V. Phone/Fax

Practice location:
  • Phone: 816-633-5774
  • Fax: 816-633-5936
Mailing address:
  • Phone: 816-633-5774
  • Fax: 816-633-5936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DARREL BOX
Title or Position: CEO LRHC
Credential:
Phone: 660-259-6852