Healthcare Provider Details

I. General information

NPI: 1114306388
Provider Name (Legal Business Name): WESTERN MISSOURI MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2015
Last Update Date: 05/07/2021
Certification Date: 05/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 FOSTER LN SUITE 201
WARRENSBURG MO
64093-3213
US

IV. Provider business mailing address

510 FOSTER LN SUITE 201
WARRENSBURG MO
64093-3213
US

V. Phone/Fax

Practice location:
  • Phone: 660-262-7415
  • Fax: 660-262-7416
Mailing address:
  • Phone: 660-262-7415
  • Fax: 660-262-7416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

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