MEDICARE: WEST PLAINS SURGICAL ASSOCIATES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	112742	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	511720482	OTHER		MEDICARE RR

General Provider Information

NPI Number	:	1548351224
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST PLAINS SURGICAL ASSOCIATES, LLC

Provider Business Mailing Address
First Line	:	805 N KENTUCKY ST
Second Line	:
City	:	WEST PLAINS
State	:	MO
Zip	:	65775-2022
Country	:	US
Telephone Number	:	417-255-2301
Fax Number	:	417-255-2303

Provider Business Practice Location Address
First Line	:	805 N KENTUCKY ST
Second Line	:
City	:	WEST PLAINS
State	:	MO
Zip	:	65775-2022
Country	:	US
Telephone Number	:	417-255-2301
Fax Number	:	417-255-2303

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. SONJA LEA STAUFFER
Credential	:	MS
Telephone Number	:	417-256-2111

Provider Enumeration Date	:	09/27/2006
Last Update Date	:	08/26/2010

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