Healthcare Provider Details

I. General information

NPI: 1124034889
Provider Name (Legal Business Name): WEST CENTRAL MISSOURI ORTHOPAEDIC SURGICAL SERIVCES P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 05/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 S INGRAM AVE
SEDALIA MO
65301-8121
US

IV. Provider business mailing address

2301 S INGRAM AVE
SEDALIA MO
65301-8121
US

V. Phone/Fax

Practice location:
  • Phone: 660-826-5890
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DR. DOUGLAS W KIBURZ
Title or Position: PHYSICIAN
Credential: MD
Phone: 660-826-5890