=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033106166
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WESTERN MISSOURI MEDICAL CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/04/2005
-----------------------------------------------------
Last Update Date | 11/08/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 415 BURKARTH RD STE A
-----------------------------------------------------
City | WARRENSBURG
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64093
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 660-429-2228
-----------------------------------------------------
Fax | 660-262-7418
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 415 BURKARTH RD STE A
-----------------------------------------------------
City | WARRENSBURG
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64093-3120
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 660-429-2228
-----------------------------------------------------
Fax | 660-429-2992
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | MICHAEL DEAN OHMART
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 660-262-7307
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR1300X
-----------------------------------------------------
Taxonomy Name | Rural Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------