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General NPI Number Information
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NPI Number | 1003070830
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Entity Type | Organization
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Legal Business Name | D/B/A WESTERN MISSOURI PEDIATRICS
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Dates
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Enumeration Date | 07/10/2008
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Last Update Date | 07/10/2008
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Provider Practice Location Address
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Address Line | 415D BURKARTH RD
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City | WARRENSBURG
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State | MO
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Zip | 64093-3101
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Country | US
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Telephone | 660-747-3141
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Fax | 660-747-7292
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Provider Business Mailing Address
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Address Line | 415D BURKARTH RD
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City | WARRENSBURG
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State | MO
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Zip | 64093-3101
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Country | US
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Telephone | 660-747-3141
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Fax | 660-747-7292
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Authorized Official
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Title or Position | PRESIDENT / CEO
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Name | MR. CRAIG J. MARKS
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Credential |
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Telephone | 660-747-2500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 221-44
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License Number State |
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