Provider Demographics
NPI:1073509733
Name:WEST PLAINS SURGERY CENTER LLC
Entity Type:Organization
Organization Name:WEST PLAINS SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:M
Authorized Official - Last Name:WORLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-256-1400
Mailing Address - Street 1:1401 DOCTORS DR
Mailing Address - Street 2:
Mailing Address - City:WEST PLAINS
Mailing Address - State:MO
Mailing Address - Zip Code:65775-4754
Mailing Address - Country:US
Mailing Address - Phone:417-256-1400
Mailing Address - Fax:417-256-2885
Practice Address - Street 1:1401 DOCTORS DR
Practice Address - Street 2:
Practice Address - City:WEST PLAINS
Practice Address - State:MO
Practice Address - Zip Code:65775-4754
Practice Address - Country:US
Practice Address - Phone:417-256-1400
Practice Address - Fax:417-256-2885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-27
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO160-0261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000040088OtherMEDICARE PTAN
MO160-0OtherSTATE LICENSE
MO507268902Medicaid