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General NPI Number Information
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NPI Number | 1477870467
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Entity Type | Organization
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Legal Business Name | WT REGIONAL MEDICAL ASSOCIATES
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Dates
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Enumeration Date | 04/29/2010
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Last Update Date | 10/30/2025
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Provider Practice Location Address
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Address Line | 108 W 15TH STREET
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City | CARUTHERSVILLE
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State | MO
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Zip | 63830-2202
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Country | US
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Telephone | 731-512-1277
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Fax |
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Provider Business Mailing Address
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Address Line | 108 W 15TH ST
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City | CARUTHERSVILLE
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State | MO
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Zip | 63830-2202
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Country | US
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Telephone | 573-333-0033
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Fax | 573-333-2522
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Authorized Official
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Title or Position | CEO
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Name | JAMES E ROSS
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Credential | PRESIDENT
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Telephone | 731-541-6735
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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