Healthcare Provider Details

I. General information

NPI: 1720409113
Provider Name (Legal Business Name): WESTERN MISSOURI MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2014
Last Update Date: 04/08/2014
Certification Date:
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: 660-747-8455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: TERRI A BRADLEY
Title or Position: VP FINANCIAL SERVICES / CFO
Credential:
Phone: 660-262-7307