Healthcare Provider Details

I. General information

NPI: 1073509733
Provider Name (Legal Business Name): WEST PLAINS SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 07/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 DOCTORS DR
WEST PLAINS MO
65775-4754
US

IV. Provider business mailing address

1401 DOCTORS DR
WEST PLAINS MO
65775-4754
US

V. Phone/Fax

Practice location:
  • Phone: 417-256-1400
  • Fax: 417-256-2885
Mailing address:
  • Phone: 417-256-1400
  • Fax: 417-256-2885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number160-0
License Number StateMO

VIII. Authorized Official

Name: MS. ANGELA M. WORLEY
Title or Position: ADMINISTRATOR
Credential:
Phone: 417-256-1400