Healthcare Provider Details

I. General information

NPI: 1295782316
Provider Name (Legal Business Name): MURPHY WATSON BURR SURGERY CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 03/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5202 FARAON ST
SAINT JOSEPH MO
64506-3840
US

IV. Provider business mailing address

5202 FARAON ST
SAINT JOSEPH MO
64506-3840
US

V. Phone/Fax

Practice location:
  • Phone: 816-233-2020
  • Fax: 816-279-4662
Mailing address:
  • Phone: 816-233-2020
  • Fax: 816-279-4662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number77-18
License Number StateMO

VIII. Authorized Official

Name: JENI CROUSE
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 816-233-2020