Healthcare Provider Details

I. General information

NPI: 1073500104
Provider Name (Legal Business Name): WESTERN MISSOURI MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 07/09/2021
Certification Date: 07/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 BURKARTH RD
WARRENSBURG MO
64093-3101
US

IV. Provider business mailing address

403 BURKARTH RD
WARRENSBURG MO
64093-3101
US

V. Phone/Fax

Practice location:
  • Phone: 660-747-2500
  • Fax: 660-747-8455
Mailing address:
  • Phone: 660-747-2500
  • Fax: 660-747-2500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number221-42
License Number StateMO

VIII. Authorized Official

Name: MICHAEL DEAN OHMART
Title or Position: CFO
Credential:
Phone: 660-262-7307