Provider Demographics
NPI:1699961862
Name:JOHN NWORA MD
Entity type:Organization
Organization Name:JOHN NWORA MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:O
Authorized Official - Last Name:NWORA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:573-333-4441
Mailing Address - Street 1:1117 WARD AVE
Mailing Address - Street 2:PO BOX 200
Mailing Address - City:CARUTHERSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63830-2622
Mailing Address - Country:US
Mailing Address - Phone:573-333-4441
Mailing Address - Fax:573-333-5142
Practice Address - Street 1:1117 WARD AVE
Practice Address - Street 2:
Practice Address - City:CARUTHERSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63830-2622
Practice Address - Country:US
Practice Address - Phone:573-333-4441
Practice Address - Fax:573-333-5142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-20
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO106331174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO207679200Medicaid
MO000014513Medicare PIN
MOF85346Medicare UPIN