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General NPI Number Information
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NPI Number | 1487865945
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Entity Type | Organization
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Legal Business Name | OMC FEE FOR SERVICE
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Dates
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Enumeration Date | 05/25/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1100 N KENTUCKY AVE
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City | WEST PLAINS
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State | MO
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Zip | 65775-2029
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Country | US
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Telephone | 417-257-6701
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1100
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City | WEST PLAINS
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State | MO
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Zip | 65775-1100
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT AND CEO
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Name | PHILIP BAGBY
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Credential |
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Telephone | 417-256-9111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 17448
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License Number State | MO
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