Healthcare Provider Details

I. General information

NPI: 1134201346
Provider Name (Legal Business Name): FAMILY PRACTICE ASSOCIATES OF WEST CENTRAL MISSOURI, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 06/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

513 BURKARTH RD
WARRENSBURG MO
64093-3103
US

IV. Provider business mailing address

1200 W 22ND ST
HIGGINSVILLE MO
64037-1420
US

V. Phone/Fax

Practice location:
  • Phone: 660-747-7751
  • Fax: 660-747-8398
Mailing address:
  • Phone: 660-584-7751
  • Fax: 660-584-8261

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DEBORAH M SKWARLO
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 660-747-5239