Provider Demographics
NPI:1972817658
Name:WESTERN MISSOURI MEDICAL CENTER
Entity type:Organization
Organization Name:WESTERN MISSOURI MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:OHMART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-262-7307
Mailing Address - Street 1:600 E ALLEN ST STE A
Mailing Address - Street 2:
Mailing Address - City:KNOB NOSTER
Mailing Address - State:MO
Mailing Address - Zip Code:65336-1184
Mailing Address - Country:US
Mailing Address - Phone:660-563-5555
Mailing Address - Fax:660-563-5558
Practice Address - Street 1:600 E ALLEN ST STE A
Practice Address - Street 2:
Practice Address - City:KNOB NOSTER
Practice Address - State:MO
Practice Address - Zip Code:65336
Practice Address - Country:US
Practice Address - Phone:660-563-5555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-05
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO792000Medicare PIN