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General NPI Number Information
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NPI Number | 1669699674
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Entity Type | Organization
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Legal Business Name | NEVADA SURGICAL ASSOCIATES LLC
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Dates
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Enumeration Date | 04/19/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 800 S ASH ST
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City | NEVADA
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State | MO
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Zip | 64772-3223
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Country | US
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Telephone | 417-448-3727
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Fax |
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Provider Business Mailing Address
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Address Line | 800 S ASH ST
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City | NEVADA
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State | MO
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Zip | 64772-3223
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Country | US
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Telephone | 417-448-3727
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOHN T WEAVER
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Credential | DO
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Telephone | 417-448-9698
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 2007011040
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License Number State | MO
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